Surgical management of cubital tunnel syndrome includes in situ nerve decompression or nerve decompression with subcutaneous or submuscular anterior transposition. Medial epicondylectomy and endoscopic decompression also are surgical treatment options. Several studies comparing types of anterior transposition and nerve stabilization for the management of cubital tunnel syndrome have reported no difference in outcomes. If the intermuscular septum is not available or of inadequate width to be used in a fascial sling, then an adipose flap can be used for anterior nerve stabilization. However, adipose flaps are contraindicated in patients with insufficient subcutaneous fat or tissue in the anterior skin flap and patients with global scarring of the extremity. Studies have not reported differences in the outcomes of these stabilization techniques; however, some surgeons prefer adipose flaps because they afford a more natural vascular and pliable adipose bed for the nerve than a fascial sling and a decreased likelihood of perineural scar formation. This video demonstrates the technique and technical pearls for anterior ulnar nerve transposition with the use of an adipose flap in a patient with an anconeus epitrochlearis muscle.