Photoacoustic and elasticity imaging for early detection of craniofacial implant-induced skin breakdown

Craniofacial implants are widely used in reconstructive surgery but often lead to complications such as skin breakdown and implant exposure. These outcomes are believed to result from implant-induced mechanical stress and disruption of the skin’s vascular integrity. In this study, we combined ultrasound-guided photoacoustic (US/PA) imaging, photoacoustic tomography (PAT), and shear wave elasticity imaging (SWEI) to monitor vascular and mechanical changes in mice skin over time following subcutaneous implantation. Two implant geometries, cube and dome, were compared. While dome-implanted and control mice maintained healthy skin, three cube-implanted mice developed implant exposure. Our results revealed prolonged mechanical stress and statistically significant early decline in vascular integrity, detectable weeks before visible skin breakdown. These findings demonstrate the potential of non-invasive imaging biomarkers to predict implant-induced skin damage and provide new insights to guide implant design and clinical intervention strategies.