BACKGROUND: In clinical practice, ultrasound assessment of the skin and superficial tissues is progressively becoming a valuable diagnostic tool to support physical examination in the outpatient setting. OBJECTIVES: The aim of this study was to define a standardized sonographic approach to (layer-by-layer) accurately evaluate multiple histological layers of the skin and superficial tissues. METHODS: Using high-frequency ultrasound probes and high-level ultrasound machines, we matched the histological microarchitecture of superficial tissues with multiple sonographic patterns in physiological and pathological conditions. Moreover, high-sensitive color/power Doppler assessments have also been performed to evaluate the microcirculation. RESULTS: Modern equipment allow for a detailed "sonographic dissection" of the skin and superficial tissues by evaluating different histological layers in various clinical scenarios. High-sensitive Doppler imaging clearly depicts the microvasculature, especially of pathologies. CONCLUSIONS: In clinical practice, using adequate technological equipment, a detailed sonographic assessment of the superficial (soft) tissues can be performed with the use of high-frequency B-mode and high-sensitive Doppler imaging.

Department of Basic Medical Sciences Neurosciences and Sense Organs Aldo Moro University Bari Italy; Department of Biological and Environmental Science and Technologies University of Salento Lecce Italy

Department of Rehabilitation Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Hacettepe University Medical School Department of Physical and Rehabilitation Medicine Ankara Turkey

Institute of Anatomy 1st Faculty of Medicine Charles University Prague Czech Republic

Pathology Unit Maggiore Hospital Bologna Italy; Department of Experimental Diagnostic and Specialty Medicine University of Bologna Bologna Italy

Physical and Rehabilitation Medicine Unit Department of Biomedical and Neuromotor Science IRCCS Rizzoli Orthopedic Institute University of Bologna Bologna Italy

Physical and Rehabilitation Medicine Unit Luigi Sacco University Hospital ASST Fatebenefratelli Sacco Milan Italy

Unit of Ultrasound in Internal Medicine Department of Medicine and Science of Aging G d'Annunzio University Chieti Italy

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