Application of Henna as a Durable Skin Marker in Orthopedic Surgery.

Mukul Mohindra,Amit Meena

doi:10.7759/cureus.10631

Abstract

BackgroundMany orthopedic procedures require skin marking well before surgery. Marks made with most conventional marking pens fade with vigorous skin preparation required before orthopedic procedures, whereas marks with henna may safely last almost up to three weeks. Thereby, we intend to describe applications of henna, a readily available, cost-effective material, as a durable skin marker for various indications in orthopedics.MethodsA total of 120 patients with varied indications for skin marking were randomized into two equal-sized groups of 60 each. Group A patients were marked with henna and group B patients with a permanent skin marker before the intended surgery. All patients had a routine pre-operative bath one day before surgery and vigorous skin preparation using chlorhexidine and ethanol-based scrubs just before surgery in the operating room. The two markers were compared for the following variables: photographic record to determine fading of the mark after scrubbing, in terms of successful execution of the procedure, patients’ acceptability of the mark, any allergy or infection, and final time of disappearance of the mark.ResultsMarking with henna was clearly visible during all but one surgical procedure even after vigorous pre-operative skin preparation, thereby ensuring minimal use of fluoroscopy in henna-marked patients. The fading of the mark and use of fluoroscopy was significantly low in group A (p<0.05). There was no complication associated with marking with either marking method. Marks with henna disappeared on an average nine days later than with permanent marker. In terms of acceptability of mark, henna was preferred by almost all patients.ConclusionsHenna paste is an ideal substance for use as a skin marker in conditions, such as foreign body removal, vertebral level identification, nail dynamization, marking tibial physis in children, and sequestrum in non-discharging osteomyelitis, and in marking blood vessel course in tumor surgery or in volar ganglion removal. Pre-operative skin marking with henna ensures minimal use of fluoroscopy, and it is particularly efficacious when ultrasound is used for localization as it can be directly applied over gel film.

Highlights

All orthopedic procedures must be precisely targeted to be efficacious and effective and to avoid inadvertent damage to normal healthy tissue
The fading of the mark and use of fluoroscopy was significantly low in group A (p
Henna paste is an ideal substance for use as a skin marker in conditions, such as foreign body removal, vertebral level identification, nail dynamization, marking tibial physis in children, and sequestrum in nondischarging osteomyelitis, and in marking blood vessel course in tumor surgery or in volar ganglion removal

Summary

Introduction

All orthopedic procedures must be precisely targeted to be efficacious and effective and to avoid inadvertent damage to normal healthy tissue Attempting to avoid this deviation in the target point, we often end up making indiscriminate use of intra-operative fluoroscopy that incurs harm to both the patient and the surgeons. Skin marking with a permanent marker has been used since long just before the surgery, but marks made with most conventional marking pens fade or disappear with vigorous skin preparation that is generally required before performing orthopedic procedures. Thereby, we intend to describe the use of henna, a low cost widely available material, as a durable pre-operative skin marker in orthopedic procedures. Thereby, we intend to describe applications of henna, a readily available, cost-effective material, as a durable skin marker for various indications in orthopedics

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Conclusion