5). The donor site was closed primarily. The patient was most recently seen 6 months post-operatively,

at which time his flap was healthy and viable; the patient was able to close the eye without lagophthalmos, visual changes, or diplopia (Fig. 6). The donor site healed with minimal morbidity (Fig. 7). The UFFF was first described by Lovie et al. [3] Other flaps were previously the mainstay of head and neck reconstruction, including the pectoralis major myocutaneous, lateral upper arm, and vastus lateralis flaps.[2, 7] The radial forearm flap and anterolateral thigh flaps remain important tools in head and neck reconstruction.[19, 20] However, many RNA Synthesis inhibitor of these flaps posed three-dimensional reconstruction RAD001 clinical trial issues and anastomosis difficulties due to the bulkiness of the tissue.[6] However, the UFFF is a thin, pliable flap that is also versatile enough for the delicate structures of the head and neck, especially intraoral defect repairs.[13] The UFFF is also technically easy to harvest, with excellent vasculature ideal for head and neck reconstruction.[7] Unlike the diameter of the radial artery, the diameter of the ulnar artery is similar to the venae comitantes’, allowing for better size match for both

artery and vein to the corresponding vessels in the head and neck.[18] Our case also demonstrated perforators supplying the UFFF. In a study by Yu et al.,[18] perforator location in 38 UFFFs were determined by arm proportions; with the pisiform at the wrist crease designated as point 0, the epicondyle as 1.0, and the midpoint as 0.5, perforators were typically

located 0.3, 0.4, and 0.5 cm ulnar to the pisiform-to-epicondyle line. In this study of 38 patients undergoing repair of head and neck defects with SPTLC1 UFFFs, all patients had two (39%) or three (61%) perforators.[18] The robust vasculature of the UFFF would thus allow for the viability of UFFFs when utilized in head and neck reconstruction. This point is emphasized by so few flap losses in this review. One thing to note is the pedicle length of the UFFF; Sieg et al.[2] reported a long pedicle length compared with alternative transplants but shorter than the radial equivalent. An additional consideration when using the UFFF is the presence of a superficial ulnar artery in place of the normal ulnar artery. In a study by Sieg et al.,[11] none of these vascular anomalies were identified preoperatively by the Allen’s test, only intra-operatively during dissection. In this study, four (3.7%) cases out of 107 UFFFs demonstrated a superficial ulnar artery; however, the smaller superficial ulnar artery was still able to adequately perfuse these flaps, keeping the reconstructed sites viable and healthy.