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.

IntroductionThe WHO Safer Surgery checklist has become an important component of perioperative safety. Our objective, was to determine the compliance of completing the checklist for paediatric emergency plastic surgery patients at our unit.MethodsAn initial baseline was performed with 70 patients over two months at our unit. Following this, we raised awareness at an audit meeting and closed the audit loop using 80 patients over two months. The audit is reported in line with SQUIRE 2.0 criteria.ResultsInitial compliance was 88% overall and this increased to 91% post-intervention. Compliance with the individual stages in both cycles was for sign-in: 85%–86%, for time-out 92%–98% and for sign-out 86%–89%. Around one in four checklists were not scanned in both periods.ConclusionThis audit showed a high overall level of compliance in the checklists that were scanned and available for scrutiny. We have identified the areas that most need improvement and suggest ways for doing so.

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