Comparing Minimally Invasive and Conventional Approaches to DIEP Flap Harvest: A Matched-Pair Analysis from a High-Volume Center.

[AIMS] Several approaches aim to reduce donor site morbidity in harvesting autologous deep inferior epigastric perforator (DIEP) flaps. This study aimed to demonstrate a short fasciotomy technique for DIEP flap harvest and to quantify the outcomes, analgesia requirements, and time to mobility compared with the conventional approach.

[METHODS] This retrospective, single-center study included 22 patients who underwent unilateral breast reconstruction with autologous DIEP flaps between November 1, 2023 and March 1, 2025, performed by a single surgeon. Patients undergoing minimally invasive DIEP flap harvest were matched with those receiving conventional DIEP flap harvest based on key variables and characteristics.

[RESULTS] Eleven patients underwent minimally invasive DIEP flap harvest with a mean operating time of 323.54 minutes. The mean length of fasciotomy was 2.79 cm in the minimally invasive group and 9.72 cm in the conventional group. The time to first mobility was 1.18 days in the minimally invasive cohort and 2.09 days in the control group (p = 0.0013). The postoperative mean total strong opioid requirement was 18 mg in the minimally invasive cohort and 42 mg in the control group (p < 0.001). Patients in the minimally invasive cohort were discharged significantly earlier, with a mean of 5.2 days (p < 0.0001). No flap loss occurred in either group.

[CONCLUSIONS] Minimally invasive DIEP flap harvesting using small fasciotomies is a safe and promising technique that minimizes functional donor site morbidity and offers reliable outcomes, including faster mobilization, reduced postoperative opioid use, and shorter hospital stays.

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