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Abstract：
The deep inferior epigastric artery 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. We therefore aimed to identify crucial factors that might increase the risk for abdominal bulging and an impaired aesthetic appearance. We conducted a multicenter study evaluating all patients receiving autologous breast reconstruction using a DIEP flap between 2013 and 2017. Medical records were analyzed with special attention to flap technique, number of perforators, localization of perforator, and donor site complications. In addition, the aesthetic appearance of the abdominal donor site was evaluated by blinded clinicians at one-year follow-up. A total of 242 patients underwent DIEP flap breast reconstruction. Abdominal bulging occurred in 7%. Further subgroup analysis revealed a significant correlation between abdominal bulging and two or more perforators (P = .003), the use of lateral row perforators (P = .009), and a higher BMI (P = .002). Obesity (P = .003) and higher patient\'s age (P = .003) could be identified as risk factors for an undesirable appearance of the donor site. We recommend the use of a medial-row single perforator whenever possible in order to optimize donor site morbidity and decrease the risk of abdominal bulging. Proper patient selection and careful donor site closure following a standardized approach should be performed to limit the risk of aesthetically undesirable results.
摘要：
深腹壁下动脉穿支皮瓣（DIEP）由于其自然的美学效果和保留肌肉的设计，在自体乳房重建中获得了广泛的普及。然而,关于美学结果的供体部位结果通常不太有利。因此，我们旨在确定可能增加腹部膨出和美学外观受损风险的关键因素。我们进行了一项多中心研究，评估了2013年至2017年间使用DIEP皮瓣接受自体乳房重建的所有患者。对病历进行分析，特别注意皮瓣技术，射孔器的数量,射孔器的国产化,和供体部位并发症。此外,在1年的随访中,盲法临床医师对腹部供血部位的外观进行了评估.共242例患者行DIEP皮瓣乳房再造。7%发生腹部膨出。进一步的亚组分析显示，腹部膨出与两个或两个以上穿支之间存在显着相关性（P=0.003），侧排射孔器的使用(P=.009)，和较高的BMI（P=0.002）。肥胖（P=.003）和较高的患者年龄（P=.003）可以被确定为供体部位出现不良外观的危险因素。我们建议尽可能使用内侧排单穿孔器，以优化供体部位的发病率并降低腹部膨出的风险。应按照标准化方法进行正确的患者选择和仔细的供体部位闭合，以限制美学上不良结果的风险。
