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Syringe pen: An alternative skin-marking tool in dermatologic surgery
SURGICAL
PEARLS
Syringe pen: An alternative skin-marking tool in dermatologic surgery Gerson Dellatorre, MD, and Felipe Bochnia Cerci, MD Curitiba, Brazil Key words: cutaneous surgery; cutaneous surgical procedures; dermatologic surgery; intraoperative period; methylene blue; skin surgery.
SURGICAL CHALLENGE Intraoperative skin marking is an essential step of surgical planning. Marking pens or toothpicks embedded with ink are commonly used for this purpose. However, pens may not work ideally after contact with blood and toothpicks alone may be challenging to handle.
SOLUTION We describe an alternative tool for sterile skin marking during dermatologic surgery. The following sterile materials are necessary to build a ‘‘syringe pen’’ in a few steps (Fig 1): d Blue methylene, 1 mL; d Surgical cup; d 3-mL Syringe; d Toothpick; d Hemostat. This handmade tool has a few advantages when compared with regular marking pens or toothpicks. The syringe pen is less expensive than regular marking pens. Moreover, it does not dry during a prolonged surgery or after contact with blood. When compared with a toothpick alone, the syringe pen is easier to handle (Fig 2) and does not need to be repetitively moistened with ink because its wood tip is constantly in contact with the ink inside the syringe. If necessary, the plunger may be carefully pressed until the methylene blue reaches the distal part of the toothpick. Excessive pressure must be avoided as it may dislodge the toothpick from the syringe. One disadvantage of the syringe pen is the effort and time it requires to be prepared. However, with practice, it may be set up in less than a minute. The described tool is a cost-effective method that provides ergonomic intraoperative sterile marking.
From the Department of Dermatology, Hospital Santa Casa de Curitiba. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Gerson Dellatorre, MD, Department of Dermatology, Hospital Santa Casa de Curitiba, Prac¸a Rui Barbosa, 245,
Centro, Curitiba, PR, Brazil 80010-030. E-mail: dellatorre@gmail. com. J Am Acad Dermatol 2015;73:e179-80. 0190-9622/$36.00 Ó 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.07.011
e179
e180 Dellatorre and Cerci
J AM ACAD DERMATOL
NOVEMBER 2015
Fig 1. A, Methylene blue is aspired with a syringe. B, Next, one-third of the toothpick is broken off. C, With a hemostat, the one-third portion of the toothpick is partially inserted on the syringe tip until it is stable. D, In a few seconds, methylene blue diffuses to the toothpick reaching its tip and the syringe pen is ready for use.
Fig 2. A, Syringe pen used to design a paramedian forehead flap to restore a nasal defect after Mohs micrographic surgery. B, Flap demarcated.
PEARLS
Syringe pen: An alternative skin-marking tool in dermatologic surgery Gerson Dellatorre, MD, and Felipe Bochnia Cerci, MD Curitiba, Brazil Key words: cutaneous surgery; cutaneous surgical procedures; dermatologic surgery; intraoperative period; methylene blue; skin surgery.
SURGICAL CHALLENGE Intraoperative skin marking is an essential step of surgical planning. Marking pens or toothpicks embedded with ink are commonly used for this purpose. However, pens may not work ideally after contact with blood and toothpicks alone may be challenging to handle.
SOLUTION We describe an alternative tool for sterile skin marking during dermatologic surgery. The following sterile materials are necessary to build a ‘‘syringe pen’’ in a few steps (Fig 1): d Blue methylene, 1 mL; d Surgical cup; d 3-mL Syringe; d Toothpick; d Hemostat. This handmade tool has a few advantages when compared with regular marking pens or toothpicks. The syringe pen is less expensive than regular marking pens. Moreover, it does not dry during a prolonged surgery or after contact with blood. When compared with a toothpick alone, the syringe pen is easier to handle (Fig 2) and does not need to be repetitively moistened with ink because its wood tip is constantly in contact with the ink inside the syringe. If necessary, the plunger may be carefully pressed until the methylene blue reaches the distal part of the toothpick. Excessive pressure must be avoided as it may dislodge the toothpick from the syringe. One disadvantage of the syringe pen is the effort and time it requires to be prepared. However, with practice, it may be set up in less than a minute. The described tool is a cost-effective method that provides ergonomic intraoperative sterile marking.
From the Department of Dermatology, Hospital Santa Casa de Curitiba. Funding sources: None. Conflicts of interest: None declared. Reprint requests: Gerson Dellatorre, MD, Department of Dermatology, Hospital Santa Casa de Curitiba, Prac¸a Rui Barbosa, 245,
Centro, Curitiba, PR, Brazil 80010-030. E-mail: dellatorre@gmail. com. J Am Acad Dermatol 2015;73:e179-80. 0190-9622/$36.00 Ó 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.07.011
e179
e180 Dellatorre and Cerci
J AM ACAD DERMATOL
NOVEMBER 2015
Fig 1. A, Methylene blue is aspired with a syringe. B, Next, one-third of the toothpick is broken off. C, With a hemostat, the one-third portion of the toothpick is partially inserted on the syringe tip until it is stable. D, In a few seconds, methylene blue diffuses to the toothpick reaching its tip and the syringe pen is ready for use.
Fig 2. A, Syringe pen used to design a paramedian forehead flap to restore a nasal defect after Mohs micrographic surgery. B, Flap demarcated.