Purpose

To evaluate the feasibility and clinical utility of high-frequency ultrasound (HFUS), color Doppler imaging, and shear-wave elastography (SWE) in the early postoperative assessment of eyelid flap and full-thickness skin graft (FTSG) reconstructions following tumor excision.

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Methods

Adult patients undergoing eyelid reconstruction after tumor excision were prospectively recruited from the Department of Ophthalmology of the University Hospital of Heraklion. Reconstruction techniques included trans-eyelid flaps (Hughes’ and reverse Hughes’ flaps) and FTSGs. All patients underwent imaging on the 1st postoperative week using a high-resolution ultrasound system (LOGIQ E9, GE Healthcare) with linear transducer (8–18 MHz for HFUS and 2–8 MHz for SWE). HFUS was used to delineate graft and flap architecture, while color Doppler assessed vascular perfusion. SWE was performed to quantify flap and graft tissue rigidity (kPa), compared to adjacent recipient tissue.

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Results

Fifteen patients were included (with 5 FTSGs, 8 Hughes’ flaps and 2 reverse Hughes’ flaps). HFUS successfully delineated flap and graft margins in all cases. Color Doppler detected vascular signals in all flaps and in 3/5 (60%) FTSGs. FTSGs demonstrated lower rigidity by SWE compared to recipient tissue (mean 18.6 ± 4.2 kPa vs 26.9 ± 5.1 kPa, p = 0.02) whereas flaps demonstrated higher respective rigidity (mean 34.7 ± 6.8 kPa vs 27.5 ± 5.6 kPa, p = 0.01). Intergroup comparison showed significantly higher stiffness in flaps compared to FTSGs (34.7 ± 6.8 kPa vs 18.6 ± 4.2 kPa, p < 0.001).

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Conclusion

Combined HFUS, color Doppler, and SWE represent a feasible, non-invasive approach for early postoperative evaluation of eyelid reconstruction assessing structural integrity, vascular perfusion, and biomechanical properties as objective indicators of tissue integration and viability. This multimodal approach shows potential as an early imaging biomarker to support grading of graft and flap viability and guide postoperative management. Larger prospective studies are needed to validate these findings and define its role in clinical decision-making.

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Additional Authors

First name	Last name	Base Hospital / Institution
Vassilios	Batis	University of Crete
Eleni	Drakonaki	University of Crete

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