Lindenblatt Nicole, Gruenherz Lisanne, Farhadi Jian
Department of Plastic and Reconstructive Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas Hospital, London, UK.
Gland Surg. 2019 Aug;8(4):389-398. doi: 10.21037/gs.2019.06.05.
The deep inferior epigastric perforator flap (DIEP) has gained widespread popularity in autologous breast reconstruction due to its natural aesthetic results and muscle-sparing design. However, donor site results regarding aesthetic outcome are often less favorable. Despite several studies on surgical technique and improvements of flap harvest, only a small number of studies addressing donor site aesthetic exist.
A systematic review was performed on donor site aesthetic after DIEP flap harvest according to the PRISMA guidelines. Secondary interests were abdominal wall morbidity and complication rates in general. The following electronic databases were included to identify relevant studies: Medline, Embase, PubMed, Cochrane, and Web of Science.
The search yielded 95 articles for full-text analysis, with only four key studies found on donor site aesthetic specifically. Regarding complication rates, the overall rate of abdominal hernia ranges from 0 to 7.1%. Abdominal bulging occurs in 2.3% to 33%. Besides abdominal wall integrity, wound dehiscence (12-39%), seroma (1-48%), hematoma (1-15%), infections (1-12%), fat necrosis (0-11%) and umbilical necrosis (2-3%) significantly impair donor site aesthetic.
This systematic review reveals that the topic of donor site aesthetic and potential improvement of results has largely been neglected in the past decade. This study provides a thorough evaluation of potential problems that plastic surgeons may encounter and includes recommendations to improve results.
腹壁下深动脉穿支皮瓣（DIEP）因其自然的美学效果和保留肌肉的设计，在自体乳房重建中得到了广泛应用。然而，供区的美学效果往往不尽人意。尽管有多项关于手术技术和皮瓣切取改进的研究，但关于供区美学的研究却很少。
根据PRISMA指南，对DIEP皮瓣切取后的供区美学进行了系统综述。次要关注点是腹壁发病率和总体并发症发生率。纳入了以下电子数据库以识别相关研究：Medline、Embase、PubMed、Cochrane和Web of Science。
检索得到95篇文章进行全文分析，仅发现4项专门针对供区美学的关键研究。关于并发症发生率，腹壁疝的总体发生率为0%至7.1%。腹壁膨出发生率为2.3%至33%。除腹壁完整性外，伤口裂开（12% - 39%）、血清肿（1% - 48%）、血肿（1% - 15%）、感染（1% - 12%）、脂肪坏死（0% - 11%）和脐坏死（2% - 3%）显著影响供区美学。
本系统综述表明，在过去十年中，供区美学这一主题以及结果的潜在改善在很大程度上被忽视了。本研究对整形外科医生可能遇到的潜在问题进行了全面评估，并提出了改善结果的建议。
