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Optimizing Donor Site Morbidity in DIEP Flap: Advancements in Minimizing Anterior Fascial Defects � A Scoping Review
Diwakar Phuyal MBBS, Isaac Mordukhovich BA, James Gaston BA1, Arturo J. Rios-Diaz, MD, Osama Darras, MD1; Rommy Obeid BS1; Fuad Abbas BS1; Graham Schwarz, MD, MSE, FACS; Risal Djohan, MD; Raffi Gurunian MD, PhD, Sarah N Bishop MD
Cleveland Clinic Foundation
2025-01-10
Presenter: Diwakar Phuyal
Affidavit:
Yes
Director Name: Raymond Isakov
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction:
Numerous minimally invasive deep inferior epigastric perforator flap (MI-DIEP) techniques have been described in literature to reduce donor site morbidities. This systematic review aimed to summarize existing MI-DIEP techniques and postoperative outcomes relative to conventional harvest (cDIEP).
Methods
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Articles were included if they described DIEP harvesting surgical techniques and abdominal donor site outcomes. Studies without perioperative information or patient outcomes were excluded. Freeman Tukey arcsine transformation was performed to compare complication rates (partial flap loss, total flap loss, hernia or bulge, and fat necrosis) in MI-DIEP versus cDIEP. Joanna Briggs Institute (JBI) critical appraisal tool was used for bias assessment.
Results
Twenty articles were included: three cadaveric studies, two case reports, fourteen retrospective reviews, and one randomized controlled trial. Eight hundred eighty patients underwent MI-DIEP. Techniques included robotic DIEP (rDIEP) (n=85), abdominal perforator exchange (APEX) (n=201), laparoscopic (n=38), endoscopic (n=94), two-staged delayed DIEP (n=135), short fasciotomy (n=124), short and ultrashort pedicle (n=26), vascular pedicle measuring technique (n=209), and microfascial incision (n=92) techniques. There were no significant differences in complications between MI-DIEP and cDIEP techniques. Bias in randomization and confounding control were observed among studies.
Conclusion/ Discussion:
Various novel minimally invasive surgical techniques were described to reduce abdominal donor site morbidity during DIEP harvest. While most studies reported comparable short-term bulge/hernia rates between minimally invasive and conventional DIEP techniques, analyses were restricted by inconsistent follow-up, risk of bias, underpowered sample sizes, and heterogeneity.
