Abstract
Background
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).
Methods
A 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.
Results
A 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).
Conclusion
MI-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
