To explore the clinical application value of high-frequency ultrasound （HFUS） combined with shear wave elastography （SWE） in the quantitative evaluation of the thickness and hardness of hypertrophic scars （HS）， and provide a new method for the objective diagnosis and efficacy monitoring of scars.

Forty patients with HS （77 scars） after burn and scald injury，admitted to the Department of Burns and Plastic Surgery of Guangzhou Red Cross Hospital of Ji′nan University， from July 2024 to February 2025 were selected for this study. The Vancouver scar scale （VSS） scoring， HFUS for thickness measurement， and SWE for hardness measurement were performed respectively， and the results were compared with pathological findings. Multiple linear regression was used to analyze the influencing factors of the thickness and hardness of scars.

Both the thickness and hardness values of HS were significantly higher than those of normal skin （Z=6.567， P<0.001；Z=-6.535，P<0.001）. With pathology as the gold standard， ultrasound demonstrated superior accuracy to VSS in evaluating scar thickness （R²=0.930 vs. R²=0.723） and hardness （R²=0.909 vs. R²=0.738）. Multiple linear regression analysis showed that the location of the scar was an independent influencing factor for hardness differences， and facial and cervical scars showed significantly reduced hardness differences compared to limb （P=0.004）.

The combination of HFUS and SWE can objectively and quantitatively evaluate the thickness and hardness of HS， demonstrating results highly consistent with pathology and superior to the subjective evaluation of VSS. It has important clinical value in the objective diagnosis， treatment decision-making， and efficacy monitoring of scars.