Does the Type of Skin Marker Prevent Marking Erasure of Surgical-Site Markings?

Objective: Site marking is essential to prevent wrong-site surgery, and there are many skin markers commercially available. However, preoperative skin preparation can erase the sitemark, especiallywhen a chlorhexidine skin preparation solution that requires skin scrubbing is used. The purpose of our study was to test the hypothesis that some markers can withstand skin preparation with a chlorhexidine-based skin preparation solution in a manner similar to that of an iodine-based solution.Methods:On each of 5 cadaveric skin flaps, we made 2 rows of site markings with 9 types of markers. We then subjected one row of markings on each flap to a chlorhexidine-based solution and the other row to an iodine-based solution. A digital photograph was taken before and after each skin prepa-ration. Using imaging software, the contrast in grayscale between the skin and skinmark-ing was measured on each photograph. The effect of the type of marker and skin prepa-ration solution on the difference in grayscale contrast was evaluated by multiple linear regression analysis and significant differences were determined (P <.05). Results: In all cases, the chlorhexidine-based skin preparation solution significantly decreased the contrast measured. No marker was significantly better than another. Conclusions: W