A Meta-analysis of Nontraditional Uses of Deep Inferior Epigastric Artery Perforator Flaps

The deep inferior epigastric artery perforator (DIEP) flap is well established for breast reconstruction, yet its use in other anatomical regions remains insufficiently characterized. Existing literature consists largely of narrative reviews and isolated case reports. Therefore, we conducted a systematic review to evaluate the effectiveness of the DIEP flap in nonbreast reconstructive surgery.

A systematic search was performed following PRISMA guidelines. Of 328 initial titles, 117 articles underwent full-text review, and 89 studies met inclusion criteria.

A total of 467 patients underwent nonbreast reconstruction using the DIEP flap. The mean age was 46.24 (range, 19-78) years. Reconstructions were performed in the head and neck (n = 122), lower limb (n = 115), upper limb (n = 95), vaginal region (n = 72), hip and thigh (n = 41), and trunk (n = 22). Nineteen total flap losses were reported, yielding an overall pooled survival rate of 96%. Region-specific survival rates were as follows: head and neck, 97%; lower limb, 93%; upper limb, 95%; vaginal, 95%; hip and thigh, 98%; and trunk, 95%. Donor-site morbidity was low, with only 13 cases (2.78%) reporting complications; the remaining 454 (97.22%) patients achieved primary donor-site closure without adverse events.

This systematic review demonstrates that the DIEP flap is a reliable option for reconstruction beyond the breast, with consistently high survival rates across multiple anatomical regions and minimal donor-site morbidity. These findings support the DIEP flap as a versatile and effective reconstructive tool, particularly in complex cases requiring durable soft tissue coverage and favorable functional outcomes.