Reconstructing Discontinuous Facial Defects with Simultaneous Ulnar Perforator Free Flaps

Multiple, simultaneous skin cancers of the face are common. This is the first description of reconstructing discontinuous facial defects (i.e., separate sites of the face) with simultaneous ulnar perforator flaps. The distinct innovations of this multiple flap design are the ability to restrict the harvest site to one extremity, to obtain vein and arterial grafts from the same extremity, and to create multiple flaps with minimal hirsutism and bulk. We present a case of a 57-year-old male with multiple basal cell carcinomas who underwent wide local excisions of the right upper lip and cheek and of the left lower eyelid and infraorbital cheek. Two left-sided ulnar perforator free flaps were used for reconstruction with the outcome of normal oral competence and eyelid function. When faced with discontinuous facial defects, reconstruction with simultaneous ulnar perforator flaps is a useful option because of the advantages of matching the thinness and pliability of the resected skin, reducing the number of harvest sites and preventing the distortion and contraction that can be seen with local advancement flaps or skin grafts.