Acta Chir Plast. 2024;66(1):10-15. doi: 10.48095/ccachp202410.
The deep inferior epigastric perforator (DIEP) flap is widely considered as the gold standard in breast reconstruction. The inset technique of the DIEP flap is crucial in determining the overall aesthetic outcome; however, to date no systematic review is available that comprehensively assesses the various techniques. Evaluation of topic: A systematic review was performed according to the PRISMA guidelines. The methodology is outlined within our published protocol (Prospero CRD42023449477). Included articles met a minimal criterion compromising of the intervention (DIEP free flap for breast reconstruction) and outcomes (aesthetic and clinical outcomes). Six articles were included in this review, with a total of 346 patients and a follow-up ranging from 6 months to 4 years. Four articles were of a prospective case series study design, one article was a randomized controlled trial, and one article was a case-control study. The risk of bias was assessed to be high in the case series, but low and moderate in the randomized controlled trial and case-control study respectively.
Although limited by the quality of the evidence, the single aesthetic unit principle, dual-plane inset, elimination of the need for a skin paddle, appropriate flap positioning and rotation, and algorithmic in-setting may all improve the aesthetic outcome of DIEP free flaps.
深部腹壁下动脉穿支皮瓣（DIEP）被广泛认为是乳房重建的金标准。DIEP 皮瓣的植入技术对于整体美学效果至关重要；然而，迄今为止，尚无系统评价全面评估各种技术。
根据 PRISMA 指南进行了系统评价。该方法在我们已发表的方案（Prospero CRD42023449477）中进行了概述。符合纳入标准的文章需要满足最低干预标准（DIEP 游离皮瓣用于乳房重建）和结局标准（美学和临床结局）。本综述共纳入 6 篇文章，总计 346 例患者，随访时间从 6 个月到 4 年不等。其中 4 篇为前瞻性病例系列研究设计，1 篇为随机对照试验，1 篇为病例对照研究。病例系列研究的偏倚风险较高，而随机对照试验和病例对照研究的偏倚风险则较低和中度。
尽管受到证据质量的限制，但单一美学单位原则、双平面植入、消除皮瓣的需要、适当的皮瓣定位和旋转，以及算法性植入等方法都可能改善 DIEP 游离皮瓣的美学效果。
