Mears Simon C, Davani Arman B, Belkoff Stephen M
International Center for Orthopaedic Advancement, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Eplasty. 2009 Sep 9;9:e36.
Site marking is essential to prevent wrong-site surgery, and there are many skin markers commercially available. However, preoperative skin preparation can erase the site mark, especially when 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.
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 preparation. Using imaging software, the contrast in grayscale between the skin and skin marking was measured on each photograph. The effect of the type of marker and skin preparation solution on the difference in grayscale contrast was evaluated by multiple linear regression analysis and significant differences were determined (P < .05).
In all cases, the chlorhexidine-based skin preparation solution significantly decreased the contrast measured. No marker was significantly better than another.
We conclude that all 9 skin markers are significantly erased with the chlorhexidine-based skin preparation solution. The development of a better skin marker or a chlorhexidine-based skin preparation solution that does not erase site markings is essential to prevent wrong-site surgeries and promote patient safety.
手术部位标记对于防止手术部位错误至关重要，市面上有许多皮肤标记物可供使用。然而，术前皮肤准备可能会擦掉手术部位标记，尤其是当使用需要擦洗皮肤的氯己定皮肤准备溶液时。我们研究的目的是检验这样一个假设，即某些标记物能够以类似于碘基溶液的方式耐受基于氯己定的皮肤准备溶液。
在5个尸体皮瓣上，我们用9种类型的标记物制作了2排手术部位标记。然后，我们对每个皮瓣上的一排标记使用基于氯己定的溶液处理，另一排标记使用碘基溶液处理。在每次皮肤准备前后拍摄数码照片。使用成像软件，测量每张照片上皮肤与皮肤标记之间的灰度对比度。通过多元线性回归分析评估标记物类型和皮肤准备溶液对灰度对比度差异的影响，并确定显著差异（P <.05）。
在所有情况下，基于氯己定的皮肤准备溶液均显著降低了测量的对比度。没有一种标记物明显优于其他标记物。
我们得出结论，基于氯己定的皮肤准备溶液会显著擦除所有9种皮肤标记物。开发一种更好的皮肤标记物或一种不会擦除手术部位标记的基于氯己定的皮肤准备溶液对于防止手术部位错误和提高患者安全至关重要。
