The ulnar forearm free flap (UFFF) was first described by Lovie et al. in 1984 as an alternative to the radial forearm free flap. The arterial supply is from the ulnar artery distal to the common interosseous branch and the paired venae comitantes. The UFFF offers similar advantages to the radial forearm free flap (RFFF) in terms of tissue pliability, size, thickness, reliability, and vessel caliber. The primary advantages of the UFFF over the RFFF include improved cosmesis of the donor site and less hair-bearing skin. The UFFF can also be considered an alternative option in the setting of a radially-dominant vascular supply to the hand.