{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:42:49Z","timestamp":1792888969032,"version":"4.5.0"},"reference-count":48,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>A total of 978 patients underwent 1,272 MI-DIEP flap harvests across 17 studies. Techniques included robotic DIEP (rDIEP; n\u2009=\u200997), abdominal perforator exchange (APEX; n\u2009=\u2009158), laparoscopic (n\u2009=\u200939), endoscopic (n\u2009=\u200994), two-staged delayed DIEP (n\u2009=\u2009135), short fasciotomy (n\u2009=\u2009124), short pedicle (n\u2009=\u200926), vascular pedicle measuring (n\u2009=\u2009209), and microfascial incision (n\u2009=\u200981). 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\u2009=\u20090.04), while APEX and vascular pedicle measuring techniques had lower fat necrosis rates (1.99% and 0.48% vs. 5.81%, p\u2009=\u20090.04 and 0.004 respectively). Short fasciotomy was associated with higher fat necrosis (12.9% vs. 5.8%, p\u2009=\u20090.004) and longer hospital stay (p\u2009=\u20090.005). 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\u2009&lt;\u20090.001).<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1055\/a-2659-6939","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T23:38:03Z","timestamp":1752881883000},"page":"351-360","source":"Crossref","is-referenced-by-count":6,"title":["Optimizing Donor Site Morbidity in DIEP Flap Reconstruction: Advancements in Minimizing Anterior Fascial Defects: A Systematic Review"],"prefix":"10.1055","volume":"42","author":[{"given":"Diwakar","family":"Phuyal","sequence":"additional","affiliation":[{"name":"Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Mordukhovich","sequence":"additional","affiliation":[{"name":"Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Gaston","sequence":"additional","affiliation":[{"name":"Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo J.","family":"Rios-Diaz","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Darras","sequence":"additional","affiliation":[{"name":"Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rommy","family":"Obeid","sequence":"additional","affiliation":[{"name":"Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risal","family":"Djohan","sequence":"additional","affiliation":[{"name":"Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffi","family":"Gurunian","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N.","family":"Bishop","sequence":"additional","affiliation":[{"name":"Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref1","first-page":"405163","article-title":"Patient satisfaction and quality of life in DIEAP flap versus implant breast reconstruction","volume":"2015","author":"R Sgarzani","year":"2015","journal-title":"Surg Res Pract"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"e1217","DOI":"10.1097\/GOX.0000000000001217","article-title":"Comparison of patient-reported outcomes after implant versus autologous tissue breast reconstruction using the BREAST-Q","volume":"5","author":"O Pirro","year":"2017","journal-title":"Plast Reconstr Surg Glob 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