The first description of the ulnar fasciocutaneous free flap was given by Lovie et al. in 1984. Although the authors stated that many properties of this flap are shared with the radial forearm flap, they highlighted specific advantages of this new flap, i.e., its virtually hairless and less obvious donor site on the proximal ulnar aspect of the forearm. In this case series of 11 patients, the authors used the flap for intraoral lining and performed reconstructions in the lower leg, using the flap as a flow-through flap, allowing restoration of a deficient distal circulation. Moreover, its use as a distally pedicled island flap for hand reconstruction and the inclusion of the flexor carpi ulnaris muscle, the palmaris longus tendon, or even parts of the ulnar bone was proposed (Lovie et al., Br J Plast Surg 37:486–492, 1984).