Background: Total flap necrosis as flap failure can cause burdensome problems for both the surgeon and patient. We performed a meta-analysis to analyze several risk factors for total flap necrosis in free flap surgery. Age, gender, diabetes mellitus (DM), hypertension (HT), duration of surgery, blood transfusions, and intraoperative intravenous fluids are discussed. Methods: We used the PubMed, Science Direct, Proquest, and Web of Science databases from January 2019 to December 2020. The selected articles described free flaps and included the number of cases according to variables and the incidence of total flap necrosis. Results: From thirteen articles, we documented 2,063 free flaps. Most of the patients were male (65,9%), and the defects were caused by malignancies (75.4%). The most common location was the head and neck (72.7%). Lateral circumflex femoral system and radial forearm are the two most common types of free flaps. Overall success free flap in this study was 93.45%, while the failure rate was 6.55%. Total necrosis was found in 23% of all postoperative complications. No significant differences in criteria for old age (> 60 years), female gender, DM, HT, and duration of surgery were found. Transfusions or intraoperative fluid administration cannot be concluded. Conclusions:  The causes of free flap failure are multifactorial and no absolute contraindications to surgery are mentioned in the literature. Some of the factors analyzed in this study were not significant as the risk of total free flap necrosis but could lead to other surgical or medical complications. However, further studies are needed.