INTRODUCTION
Medium-sized partial to full-thickness defects of the nasal dorsum, supratip, and tip remain aesthetically demanding reconstructive challenges. Midline or paramedian nasal defects are prominently central on the face and the slightest of nasal deformity or distortion after repair is perceptible. The anchor flap (aka "Peng" flap) is a bilateral advancement-rotation flap utilizing a tissue reservoir from the nasal sidewall and medial cheek. Initially described in 1987, this flap has only been updated in a few publications since that time.1-4 We aim to revisit this useful flap, discuss its variations, and highlight how it integrates into the modern reconstructive ladder.
Anatomy and Indication
The anchor flap is a single-staged random pattern flap that consists of superiorly based bilateral arms on the lateral aspects of a surgical defect. Its movement is a combination of rotation and advancement. A standing cone is removed superior to the defect in the midline. Its vascular supply is likely from small branches of the angular artery, lateral nasal artery, and dorsal nasal artery, with a rich myocutaneous pedicle. Flap necrosis is exceedingly uncommon.
The anchor flap is most suitable for nasal defects deep to the fibromuscular, perichondrium, or cartilage layer and located on the midline or paramedian distal nose (nasal tip, supratip, and dorsum). Undermining is performed in the supra-perichondrial layer on the nose and the mid-subcutaneous fat on the medial cheek. The literature indicates that the flap can be utilized in defect sizes ranging from 1.0 cm up to 1.6 cm in the horizontal axis and possibly up to 3.0 cm in the vertical axis.1,3,4
The anchor flap is ideal for patients with wide-set or flatter nasal shapes, a less acute angle of the nasofacial sulcus, and ample tissue reservoir in the medial cheek. The primary movement of the flap causes narrowing of the middle third of the nose, which can accentuate preexisting dorsal humps and aquiline nose shapes. This can lead to a sub-optimal cosmetic result. Patients who have a natural sharp slope of the nasofacial sulcus may complain of blunting of the sulcus due to the medial advancement of the cheek.
Flap Design
For nasal defects, the flap is superiorly based with rotation medially and slight advancement inferiorly. It may also be conceptualized as an inverted T-plasty with a rotational component. Over the years, there have been notable variations in the flap design (Figure 1). The initial description of the repair by Peng et al
