# Objective and Non-Invasive Evaluation of Fascial Layers Related to Surgical or Post-Traumatic Scars: A Systematic Review of the Literature

## TL;DR

This review explores non-invasive methods to evaluate scars involving fascial layers, highlighting current tools and identifying a research gap.

## Contribution

The study systematically reviews non-invasive techniques for evaluating fascial layers in surgical or post-traumatic scars.

## Key findings

- Ultrasound, MRI, and elastography are used to assess fascial scar features like sliding, thickness, and stiffness.
- There is a notable gap in scientific literature regarding fascial layer evaluation in scars.
- Current methods include qualitative ultrasound assessments and quantitative elastography techniques.

## Abstract

Background: Wound healing contributes to restoring skin integrity. However, scars affect soft tissue in all its layers, including the superficial and deep fascia; moreover, it has been demonstrated that the fibroblasts leading the scarring process develop from progenitors located in the superficial fascia. In the past, research into scar etiology has focused primarily on the dermal and epidermal layers, leaving the role of the fasciae largely overlooked. Many patients presenting with surgical or traumatic scars complain of the increased stiffness and thickness of the scar, reduced extensibility of the area surrounding it, and chronic pain persisting even after the healing process has been completed. The purpose of this systematic review is to investigate the non-invasive tools and methods employed for the objective evaluation of scars that involve fascial layers. Methods: A systematic literature search was conducted on PubMed and WOS. Registration DOI: 10.17605/OSF.IO/SDR3Q. Results: A total of 11 articles were selected; the etiologies of scars were surgical, traumatic, and other (keloids). The investigations were conducted using ultrasound, magnetic resonance imaging, strain elastography, and shear wave elastography on the visceral fasciae, superficial fascia, hypodermis, and musculoskeletal fasciae. Sliding of fasciae was assessed by ultrasound; thickness of fasciae was assessed by ultrasound and magnetic resonance imaging; stiffness was assessed by shear wave elastography and strain elastography; and the qualitative assessment was performed via ultrasound. Conclusions: Our literature review showed that ultrasound, magnetic resonance imaging, strain elastography, and shear wave elastography are currently adopted for investigating the sliding, thickness, stiffness, and qualitative features of scars involving fascial layers. Moreover, our research showed the existence of a gap in the scientific literature on this topic.