Remember me
Numerous minimally invasive deep inferior epigastric perforator flap (MI-DIEP) techniques have been described in the literature to reduce donor site morbidities. This systematic review aimed to summarize existing MI-DIEP techniques and postoperative outcomes relative to conventional harvest (cDIEP).
MethodsA systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to include articles with novel DIEP harvesting techniques. Studies without perioperative information were excluded. Chi-square and Fisher's exact test were used to compare complication rates (partial flap loss, total flap loss, hernia or bulge, and fat necrosis) in MI-DIEP with cDIEP. Joanna Briggs Institute critical appraisal tool was used for bias assessment.
ResultsA total of 978 patients underwent 1,272 MI-DIEP flap harvests across 17 studies. Techniques included robotic DIEP (rDIEP; n = 97), abdominal perforator exchange (APEX; n = 158), laparoscopic (n = 39), endoscopic (n = 94), two-staged delayed DIEP (n = 135), short fasciotomy (n = 124), short pedicle (n = 26), vascular pedicle measuring (n = 209), and microfascial incision (n = 81). No significant differences were found between endoscopic, laparoscopic, and robotic approaches compared with cDIEP. However, the short pedicle technique had higher partial flap loss (8.82% vs. 1.98%, p = 0.04), while APEX and vascular pedicle measuring techniques had lower fat necrosis rates (1.99% and 0.48% vs. 5.81%, p = 0.04 and 0.004 respectively). Short fasciotomy was associated with higher fat necrosis (12.9% vs. 5.8%, p = 0.004) and longer hospital stay (p = 0.005). Robotic, laparoscopic, endoscopic, two-staged, and APEX techniques were associated with shorter hospital stays, and rDIEP was linked to reduced postoperative day 1 pain (p < 0.001).
ConclusionMI-DIEP techniques demonstrate comparable complication rates to cDIEP, with certain methods offering benefits such as reduced fat necrosis, shorter hospital stays, and less postoperative pain.
Keywords DIEP - deep inferior epigastric artery perforator flap - robot - laparoscopic - endoscopic - minimally invasive techniques - totally extra peritoneal - transabdominal preperitoneal Publication HistoryReceived: 25 January 2025
Accepted: 24 June 2025
Accepted Manuscript online:
18 July 2025
Article published online:
25 August 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
Comments (0)