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Introduction <p>Head and neck reconstruction after oncological resection or trauma presents considerable challenges due to the region's functional and aesthetic complexity. Although various free flaps are used, the Deep Inferior Epigastric Artery (DIEP) flap remains underutilized because of concerns over flap bulk and technical difficulty. This systematic review evaluates the safety, efficacy, complications, and functional and aesthetic outcomes of DIEP flaps in head and neck reconstruction.</p> Methods <p>Following PRISMA guidelines, a systematic search was conducted in PubMed, EMBASE, Google Scholar, and Web of Science. Eligible studies included prospective and retrospective cohorts, as well as case series, that reported DIEP flap outcomes in head and neck reconstruction. Extracted data covered flap survival, complications, donor morbidity, functional recovery, aesthetic results, and patient satisfaction. Meta-analysis using R software calculated pooled proportions with 95% confidence intervals.</p> Results <p>Out of 396 identified records, 25 studies met eligibility criteria, including 666 patients and 480 DIEP flaps. The pooled flap survival rate was 96% (95% CI, 93%–98%), with low rates of total flap failure (3%) and partial necrosis (2%). Major and minor complication rates were 4% and 9%, respectively. Functional outcomes were favorable, with 86% of patients achieving satisfactory speech and 85% resuming oral intake. Aesthetic outcomes were rated good to excellent in 85% of studies, with high donor-site satisfaction and limited need for revision. Most studies were retrospective case series with low to moderate risk of bias.</p> Conclusion <p>DIEP flaps offer a reliable, muscle-sparing solution for moderate to large head and neck defects, yielding favorable functional and aesthetic outcomes with minimal donor-site morbidity, thereby supporting broader adoption in head and neck reconstruction.</p> <p>Level III evidence.</p>

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Deep inferior epigastric perforator (DIEP) flap in head and neck reconstruction: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Hatan Mortada,
  • Laith Kayyal,
  • Zaid A. Dajani,
  • Fay Alsubaie,
  • Maram Basem Beyari,
  • Mohammed AlQahtani,
  • Amr Youssef Arkoubi

摘要

Introduction

Head and neck reconstruction after oncological resection or trauma presents considerable challenges due to the region's functional and aesthetic complexity. Although various free flaps are used, the Deep Inferior Epigastric Artery (DIEP) flap remains underutilized because of concerns over flap bulk and technical difficulty. This systematic review evaluates the safety, efficacy, complications, and functional and aesthetic outcomes of DIEP flaps in head and neck reconstruction.

Methods

Following PRISMA guidelines, a systematic search was conducted in PubMed, EMBASE, Google Scholar, and Web of Science. Eligible studies included prospective and retrospective cohorts, as well as case series, that reported DIEP flap outcomes in head and neck reconstruction. Extracted data covered flap survival, complications, donor morbidity, functional recovery, aesthetic results, and patient satisfaction. Meta-analysis using R software calculated pooled proportions with 95% confidence intervals.

Results

Out of 396 identified records, 25 studies met eligibility criteria, including 666 patients and 480 DIEP flaps. The pooled flap survival rate was 96% (95% CI, 93%–98%), with low rates of total flap failure (3%) and partial necrosis (2%). Major and minor complication rates were 4% and 9%, respectively. Functional outcomes were favorable, with 86% of patients achieving satisfactory speech and 85% resuming oral intake. Aesthetic outcomes were rated good to excellent in 85% of studies, with high donor-site satisfaction and limited need for revision. Most studies were retrospective case series with low to moderate risk of bias.

Conclusion

DIEP flaps offer a reliable, muscle-sparing solution for moderate to large head and neck defects, yielding favorable functional and aesthetic outcomes with minimal donor-site morbidity, thereby supporting broader adoption in head and neck reconstruction.

Level III evidence.