{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T22:25:38Z","timestamp":1780525538110,"version":"3.54.1"},"reference-count":42,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Ultrasound shear wave elastography (SWE) noninvasively measures the stiffness of tissue by producing and measuring tissue deformation. Scar formation, a crucial aspect of wound healing, can lead to functional and aesthetic complications when pathological. While SWE has shown promise in dermatological evaluations, its role in surgical scar assessment remains underestimated. Our study aims to investigate SWE in evaluating surgical scars at the donor site after forearm free flap surgery in transgender patients. Methods: After radial forearm free flap harvesting, the donor site was grafted with a split-thickness skin graft with or without interposition of Matriderm. Eleven patients were evaluated more than one year after surgery, using SWE alongside scar characteristics, sensory outcomes, and patient satisfaction surveys. Results: Our study revealed no significant difference in stiffness (p &gt; 0.15), pigmentation (p = 0.32), or erythema (p = 0.06) between operated and non-operated sides. The interposition of Matriderm did not influence the stiffness. Patients significantly (p &lt; 0.0001) reported a loss of discrimination. Patients\u2019 subjective scar evaluation appeared in line with our quantitative and objective results. Conclusions: This study contributes to the evolving understanding of SWE\u2019s role in scar assessment, highlighting its feasibility in evaluating surgical scars. However, continued research efforts are necessary to establish SWE as a reliable and objective method for surgical scar evaluation and management.<\/jats:p>","DOI":"10.3390\/jcm13164903","type":"journal-article","created":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T06:07:35Z","timestamp":1724134055000},"page":"4903","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Shear Wave Elastography of the Skin following Radial Forearm Free Flap Surgery in Transgender Patients: Observational Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2019-002X","authenticated-orcid":false,"given":"Martino","family":"Guiotto","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Cristina","family":"Sciboz","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Arquero","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9766-5185","authenticated-orcid":false,"given":"Luigi","family":"Schiraldi","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Di Summa","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Bauquis","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3753-1222","authenticated-orcid":false,"given":"S\u00e9bastien","family":"Durand","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.hcl.2021.08.013","article-title":"Ultrasound elastography for hand soft tissue assessment","volume":"38","author":"Giambini","year":"2022","journal-title":"Hand Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.diii.2013.01.022","article-title":"Ultrasound elastography: Principles and techniques","volume":"94","author":"Gennisson","year":"2013","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.7150\/thno.18650","article-title":"Ultrasound elastography: Review of techniques and clinical applications","volume":"7","author":"Sigrist","year":"2017","journal-title":"Theranostics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2806","DOI":"10.1016\/j.ultrasmedbio.2015.06.007","article-title":"Preliminary Results on the Feasibility of Using ARFI\/SWEI to Assess Cutaneous Sclerotic Diseases","volume":"41","author":"Lee","year":"2015","journal-title":"Ultrasound Med. Biol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101636","DOI":"10.1016\/j.hansur.2024.101636","article-title":"Applications of ultrasound elastography to hand and upper limb disorders","volume":"43","author":"Billy","year":"2024","journal-title":"Hand Surg. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/016173469101300201","article-title":"Elastography: A quantitative method for imaging the elasticity of biological tissues","volume":"13","author":"Ophir","year":"1991","journal-title":"Ultrason. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1148\/radiol.14140434","article-title":"Viscoelasticity in Achilles tendinopathy: Quantitative assessment by using real-time shearwave elastography","volume":"274","author":"Aubry","year":"2015","journal-title":"Radiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.jbiomech.2010.10.025","article-title":"Characterization of muscle architecture in children and adults using magnetic resonance elastography and ultrasound techniques","volume":"44","author":"Debernard","year":"2011","journal-title":"J. Biomech."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1259\/bjr\/93042867","article-title":"Ultrasound elastography for musculoskeletal applications","volume":"85","author":"Drakonaki","year":"2012","journal-title":"Br. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"104","DOI":"10.14366\/usg.15072","article-title":"Usefulness of strain elastography of the musculoskeletal system","volume":"35","author":"Kim","year":"2016","journal-title":"Ultrasonography"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1148\/radiol.14121765","article-title":"Sonoelastography: Musculoskeletal applications","volume":"272","author":"Klauser","year":"2014","journal-title":"Radiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/srt.13139","article-title":"Differential diagnosis of basal cell carcinoma by high-resolution ultrasound elastography","volume":"28","author":"Han","year":"2022","journal-title":"Skin Res. Technol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s13075-020-02150-x","article-title":"How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography","volume":"22","author":"Santiago","year":"2020","journal-title":"Arthritis Res. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/j.ultrasmedbio.2017.02.009","article-title":"Quantitative Assessment of Skin Stiffness in Localized Scleroderma Using Ultrasound Shear-Wave Elastography","volume":"43","author":"Wang","year":"2017","journal-title":"Ultrasound Med. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.ultrasmedbio.2018.11.015","article-title":"Quantitative Assessment of Skin Stiffness Using Ultrasound Shear Wave Elastography in Systemic Sclerosis","volume":"45","author":"Yang","year":"2019","journal-title":"Ultrasound Med. Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.matbio.2018.02.020","article-title":"Therapeutic approaches to control tissue repair and fibrosis: Extracellular matrix as a game changer","volume":"71\u201372","author":"Walraven","year":"2018","journal-title":"Matrix Biol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/ijd.12553","article-title":"Squamous cell carcinoma of the skin: Epidemiology, classification, management, and novel trends","volume":"54","author":"Kallini","year":"2015","journal-title":"Int. J. Dermatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/AJP.0b013e3181f7f9bb","article-title":"Persistent pain outcomes and patient satisfaction with pain management after burn injury","volume":"27","author":"Browne","year":"2011","journal-title":"Clin. J. Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.ultrasmedbio.2016.10.002","article-title":"Quantitative Assessment of Healthy Skin Elasticity: Reliability and Feasibility of Shear Wave Elastography","volume":"43","author":"Xiang","year":"2017","journal-title":"Ultrasound Med. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1118\/1.3560421","article-title":"On the potential of ultrasound elastography for pressure ulcer early detection","volume":"38","author":"Deprez","year":"2011","journal-title":"Med. Phys."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/j.ultrasmedbio.2020.03.003","article-title":"A Novel, Reliable Protocol to Objectively Assess Scar Stiffness Using Shear Wave Elastography","volume":"46","author":"DeJong","year":"2020","journal-title":"Ultrasound Med. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hang, J., Chen, J., Zhang, W., Yuan, T., Xu, Y., and Zhou, B. (2021). Correlation between elastic modulus and clinical severity of pathological scars: A cross-sectional study. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-02730-0"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1016\/j.burns.2014.03.002","article-title":"Longitudinal burn scar quantification","volume":"40","author":"Nedelec","year":"2014","journal-title":"Burns"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1097\/01.ASW.0000527576.27489.0f","article-title":"Insights into the Pathophysiology of Hypertrophic Scars and Keloids: How Do They Differ?","volume":"31","author":"Ghazawi","year":"2018","journal-title":"Adv. Skin Wound Care"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Huang, S.Y., Xiang, X., Guo, R.Q., Cheng, S., Wang, L.Y., and Qiu, L. (2020). Quantitative assessment of treatment efficacy in keloids using high-frequency ultrasound and shear wave elastography: A preliminary study. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-58209-x"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2507","DOI":"10.1002\/jum.14608","article-title":"Determination of Normal Skin Elasticity by Using Real-time Shear Wave Elastography","volume":"37","author":"Yang","year":"2018","journal-title":"J. Ultrasound Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"449","DOI":"10.3899\/jrheum.140873","article-title":"A preliminary study of acoustic radiation force impulse quantification for the assessment of skin in diffuse cutaneous systemic sclerosis","volume":"42","author":"Hou","year":"2015","journal-title":"J. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"302","DOI":"10.5114\/pdia.2013.38359","article-title":"Age-dependent biomechanical properties of the skin","volume":"30","author":"Pawlaczyk","year":"2013","journal-title":"Postepy Dermatol. Alergol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/S0190-9622(89)70228-0","article-title":"Molecular mechanisms of cutaneous aging. Age-associated connective tissue alterations in the dermis","volume":"21","author":"Uitto","year":"1989","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_30","first-page":"s12","article-title":"The role of elastin and collagen in cutaneous aging: Intrinsic aging versus photoexposure","volume":"7","author":"Uitto","year":"2008","journal-title":"J. Drugs Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s00403-015-1538-2","article-title":"High-resolution color-Doppler ultrasound for the study of skin growths","volume":"307","author":"Sagnelli","year":"2015","journal-title":"Arch. Dermatol. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e6902","DOI":"10.1097\/MD.0000000000006902","article-title":"Reproducibility analysis on shear wave elastography (SWE)-based quantitative assessment for skin elasticity","volume":"96","author":"Sun","year":"2017","journal-title":"Medicine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"769","DOI":"10.5999\/aps.2015.42.6.769","article-title":"Stabilizing Morbidity and Predicting the Aesthetic Results of Radial Forearm Free Flap Donor Sites","volume":"42","author":"Yun","year":"2015","journal-title":"Arch. Plast. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4103\/ams.ams_228_21","article-title":"Comparison of Skin Graft Techniques with and without Plaster Back Slab Dressing in Reducing Donor Site Morbidity in Radial Forearm Free Flap Surgery\u2014A Retrospective Study","volume":"13","author":"Lakshmiah","year":"2023","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/j.burns.2023.02.009","article-title":"From qualitative data to a measurement instrument: A clarification and elaboration of choices made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0","volume":"49","author":"Tyack","year":"2023","journal-title":"Burns"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s11136-022-03244-6","article-title":"Development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0: A qualitative study","volume":"32","author":"Mokkink","year":"2023","journal-title":"Qual. Life Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1007\/s11136-014-0637-4","article-title":"Differential item functioning in the Observer Scale of the POSAS for different scar types","volume":"23","author":"Tuinebreijer","year":"2014","journal-title":"Qual. Life Res."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Gierek, M., \u0141abu\u015b, W., S\u0142abo\u0144, A., Zi\u00f3\u0142kowska, K., Ocha\u0142a-Gierek, G., Kitala, D., Szyluk, K., and Niemiec, P. (2022). Co-Graft of Acellular Dermal Matrix and Split Thickness Skin Graft-A New Reconstructive Surgical Method in the Treatment of Hidradenitis Suppurativa. Bioengineering, 9.","DOI":"10.3390\/bioengineering9080389"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s00266-017-0891-2","article-title":"Effectiveness of Acellular Dermal Matrix on Autologous Split-Thickness Skin Graft in Treatment of Deep Tissue Defect: Esthetic Subjective and Objective Evaluation","volume":"41","author":"Lee","year":"2017","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1148\/radiol.2015150908","article-title":"Quantitative Shear-Wave US Elastography of the Supraspinatus Muscle: Reliability of the Method and Relation to Tendon Integrity and Muscle Quality","volume":"278","author":"Rosskopf","year":"2016","journal-title":"Radiology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4405","DOI":"10.21037\/qims-22-1267","article-title":"Shear wave elastography-based skin assessment system for systemic sclerosis: A supplement or alternative to conventional ultrasound?","volume":"13","author":"Yang","year":"2023","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s00247-014-3150-6","article-title":"Superficial ultrasound shear wave speed measurements in soft and hard elasticity phantoms: Repeatability and reproducibility using two ultrasound systems","volume":"45","author":"Dillman","year":"2015","journal-title":"Pediatr. Radiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4903\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:39:24Z","timestamp":1760110764000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,20]]},"references-count":42,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jcm13164903"],"URL":"https:\/\/doi.org\/10.3390\/jcm13164903","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,20]]}}}