title: The ulnar fasciocutaneous free flap in head and neck reconstruction.
abstract: OBJECTIVE
  The radial forearm fasciocutaneous free flap has become the reconstructive tissue of choice for the majority of soft tissue defects in the head and neck. The forearm skin has many of the ideal soft tissue characteristics that optimize reconstruction and rehabilitation in these patients. The tissue is malleable, supple, and moldable in three dimensions; has a reliable pedicle; and can be harvested with a two-team approach. In some patients, the radial forearm cannot be used. An alternative is to use the adjacent tissue, which shares identical tissue characteristics. This tissue gets its vascular supply from the ulnar artery. The purpose of the report was to describe the authors' experience with the ulnar fasciocutaneous free flap in head and neck reconstruction.
  
  
  METHODS
  Prospective consecutive case series.
  
  
  METHODS
  Retrospective review of all patients undergoing ulnar fasciocutaneous free tissue transfer by a group of microvascular surgeons was performed. Thirty patients underwent free tissue transfer using the ulnar fasciocutaneous free flap. The male-to-female ratio was 3:1.
  
  
  RESULTS
  Defects were located in the oral cavity (14), oropharynx (12), neck skin (1), and soft tissue of the lateral skull (3). The average size of the skin paddle that was transferred was 7 x 10 cm (range, 3 x 5 to 9 x 12 cm). The mean area of tissue that was transferred was 70 cm2 (range, 15-108 cm2). Vessel sizes were somewhat smaller than the comparable radial forearm. One patient had complete loss of the skin graft on the donor site. There were no median nerve or other wound-healing problems. Two flaps were lost in the postoperative period. Indications for use of the ulnar fasciocutaneous free flap were failed Allen's test (23), use of a less hairy part of the forearm (3), and surgical preference (4).
  
  
  CONCLUSIONS
  The ulnar fasciocutaneous free flap has all of the tissue characteristics of the radial forearm flap. When a radial forearm flap cannot be used and forearm skin is desired, consideration of an ulnar fasciocutaneous free flap should be undertaken.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland 97201, USA. waxm@ohsu.edu
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
authors.forename: Eben L
authors.initials: EL
authors.lastname: Rosenthal
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Winslow
authors.forename: Daphne A
authors.initials: DA
authors.lastname: Bascom
authors.forename: Peter E
authors.initials: PE
authors.lastname: Andersen
mesh_terms: D005260:Female; D005542:Forearm; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply; D017535:Ulnar Artery