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Expanding the Criteria for Robotic Deep Inferior Epigastric Perforator Flaps: Case Report With Long Intramuscular
Diwakar Phuyal1, Osama Darras1, Raffi Gurunian2
1From the Integrated Surgical Institute, Cleveland Clinic, Cleveland, Ohio.
Plastic and Reconstructive Surgery. Global Open
|July 18, 2025
Summary
Robotic deep inferior epigastric perforator (DIEP) flap harvest can now accommodate longer intramuscular dissections. This technique expands robotic surgery applications by enabling longer pedicle harvests through smaller incisions.
Area of Science:
- Plastic Surgery
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- Robotic harvest of deep inferior epigastric perforator (DIEP) flaps is increasingly adopted by plastic surgeons.
- Current limitations restrict its use to perforators with short intramuscular lengths (<4 cm) due to larger fascial incision requirements.
Observation:
- A case report details a robotic-assisted transabdominal preperitoneal harvest of a 15-cm DIEP flap pedicle.
- This included a significant 9.1 cm intramuscular course, achieved through a minimal 3.5 cm anterior fascial incision.
Findings:
- The procedure resulted in an uneventful intraoperative and postoperative course for the patient.
- This demonstrates the feasibility of harvesting longer intramuscular DIEP flap pedicles using robotic assistance.
Implications:
- Robotic DIEP flap harvest can be expanded to include cases with longer intramuscular perforator courses.
- This technique has the potential to reduce donor-site morbidity and broaden the applicability of robotic-assisted flap harvesting.
