Which pen? A comparative study of surgical site markers.

A preoperative requirement is the correct and clear marking of a specific surgical site. We aimed to compare the ability of marker pens to withstand surgical preparation. Five volunteers with different Fitzpatrick skin types were marked with ten pens. Marked skin sites were prepared with chlorhexidine followed by chlorhexidine, betadine followed by chlorhexidine, and betadine followed by betadine. Each site was photographed in theatre. Two volunteers ranked the top three most visible marker pens from each photograph. The results showed that Sharpie® W10 black, Dual Tip (Purple Surgical), and Easimark modern regular tip (Leonhard Lang) were the best performers across all skin types. Red pen should be avoided with betadine skin preparation. The study concludes that the above named three markers are the best at withstanding surgical skin preparation. Different skin types require different colour ink for maximal clarity in marking. Biro and drywipe markers should never be used for surgical marking.