Ultrasound and Doppler assessment of postoperative skin scar after primary and repeat cesarean sections: An observational study

Abstract

Relevance: The global increase in cesarean section (CS) rates is accompanied by a growing number of repeat surgeries and, consequently, the formation of postoperative skin scars, including hypertrophic and keloid scars. While clinical and subjective methods for scar assessment are widely discussed in the literature, data on the objective morphological and hemodynamic characteristics of postoperative anterior abdominal wall skin scars in the early postoperative period remain limited.

The study aimed to evaluate the ultrasound and Doppler characteristics of postoperative skin scars in women after primary and repeat planned cesarean section in the early postoperative period.

Materials and Methods: An observational study was conducted at a tertiary-level perinatal care facility – the National Center for Perinatology and Pediatric Cardiac Surgery in Almaty. The study included women who underwent planned primary and repeat CSs. Ultrasound and Doppler examination of the postoperative skin scar was performed on postoperative days 3-4 in cases of an uncomplicated postoperative course. Scar length and thickness, echostructure and contour clarity, and regional blood flow parameters, including resistance index, pulsatility index, and degree of vascularization, were assessed. Statistical analysis was performed using nonparametric methods.

Results: Women after repeat CS demonstrated more pronounced morphological and hemodynamic changes of the postoperative skin scar compared with those after primary CS. Scar thickness and length were significantly higher. Doppler assessment revealed increased resistance index and degree of scar tissue vascularization, reflecting features of early reparative and hypertrophic processes. No statistically significant differences in pulsatility index were observed between the groups.

Conclusion: Ultrasound combined with Doppler examination allows objective assessment of postoperative skin scar condition already in the early postoperative period. The identified differences between primary and repeat CSs highlight the relevance of instrumental methods and early prevention of hypertrophic scar formation on the anterior abdominal wall.