The median artery forearm free flap: an anatomic anomaly transformed into a surgical opportunity

Upper limb anatomical anomalies and variation are common and have frequently been documented in literature. As forearm is a common site for flap harvest, these anomalies play a critical role in planning, designing, and harvesting a flap. We planned an ulnar forearm flap for head and neck reconstruction. During flap harvest, it was noted that there is a persistent median artery supplying perforators to ulnar side skin and ulnar artery was absent. We then modified our design and based our free flap on median artery. This case report describes this free median artery flap utilized for head and neck reconstruction.