LETTER TO THE EDITOR An Update: Does the Type of Skin Marker Prevent Marking Erasure of Surgical-Site Markings?

Dear Sir, We wish to provide readers with an update on an article published in Eplasty in 2009.1 Our original article reported the performance of commercially available skin marker pens after application of a chlorhexidine-based skin preparation and compared those performances with that of traditional marker pens. Preoperative skin preparation with chlorhexidine-based solution is preferred over iodine-based solution for preventing surgical-site infection.2 However, traditional skin marker pens are erased significantly more after application of chlorhexidine-based solution than with iodine-based solution.1 Since our previous publication, new pens claiming resistance to erasure have been marketed. In the current communication, we report on the ability of the new pens to withstand exposure to chlorhexidine-based preparation compared with that of a traditional marker. We also report if marks made with the new pens performed similarly when exposed to chlorhexidine-based solution versus iodine-based solution. We repeated the protocol of our previous studies1,3 using 19 fasciocutaneous skin flaps harvested from fresh white cadavers obtained from the State Anatomy Board. One skin marker (Sandel 4-in-1 Marker [skin, wide]; Sandel Medical Industries, LLC, Chatsworth, Calif) was arbitrarily chosen as a traditional marker pen to be compared with 2 new pens advertised as providing skin markings resistant to chlorhexidine-based skin preparation (Viscot 1450XL-200 Mini XL presurgical skin marker, fine tip, and Viscot 1449XL-50 XL presurgical skin marker, bold tip; Viscot Medical, LLC, East Hanover, NJ). Using Adobe Photoshop CS2 (Adobe Systems, Inc, San Jose, Calif), we measured the markerto-skin contrast before and after application of the solution. Differences were checked for significance (P < .05).