High-Frequency Ultrasound Evaluation of Cutaneous Surgical Wound Healing: An Outpatient Experience

High-frequency ultrasound (HFUS) allows non-invasive visualization of skin microarchitecture, offering quantitative assessment of dermal composition and vascularity, but its systematic use to track temporal changes in postoperative wound healing is still limited. This study aimed to describe and validate HFUS morphologic and vascular features corresponding to the biological phases of cutaneous surgical wound healing. A total of 730 patients who underwent surgical excision of skin lesions were evaluated at different postoperative intervals using high- and ultra-high-frequency ultrasound (48-70 MHz). Dermal thickness, echogenicity and vascularity were analysed with B-mode and colour Doppler imaging through quantitative and semi-quantitative methods and reproducibility was assessed using intraclass correlation coefficients (ICC) and Cohen's κ statistics. Cross-sectional analysis demonstrated a progressive structural and vascular evolution consistent with canonical healing phases: dermal thickness decreased from 2.45 ± 0.38 mm at T0 to 1.58 ± 0.21 mm at T4, while echogenicity increased from 0.5 [0-1] to 2.5 [2, 3], reflecting collagen compaction and maturation. Vascularity peaked at T2 (2.2 ± 0.5) and declined to 0.8 ± 0.3 by T4, paralleling the regression of angiogenesis. Measurement reproducibility was excellent (ICC = 0.91; κ = 0.82). HFUS morphologic patterns closely mirrored the biological sequence from inflammatory oedema through granulation and fibroplasia to collagen remodelling, providing real-time in vivo correlates of tissue repair. These findings support HFUS as a reliable, quantitative and reproducible tool for monitoring postoperative wound healing and as a potential imaging biomarker framework for early detection of abnormal scar evolution.