A NEW
SURGICAL
By B. C.
MARKING
PEN
SOMMERLAD, F.R.C.S.
St. Andrew’s Hospital, Billericay, Essex
VARIOUSdrawing instruments have been used to mark skin incisions but none appears to be completely satisfactory. The nib pen is the most popular but it is easily damaged and is frequently found to be twisted or broken when required. It requires skill and often more than one attempt to produce a continuous line and it has to be frequently dipped in ink. A two-bladed draughtsman’s pen (Weiss, 1947) can be used only in one plane. A ball-point pen (Comess and Masson, 1957) requires special ink, is difficult to sterilise and becomes clogged with skin debris. Other instruments used include a hypodermic needle (Barsky et al., Ig64), a wooden applicator stick or wooden penholder with felt nib (Tamerin and Bornstein, rgso), a cotton wool swab on a stick and an artist’s brush. These have limited ink capacity and produce a limited range of lines. A sterile disposable felt-tip pen is available but is expensive. The present instrument is constructed from a single stainless steel rod, tapered at one end where it is divided into four separate blades which can be moved together to make an adjustable four-point tip and thus produce lines of varying width. The adjustment is made by a small knurled sleeve which, when screwed proximally, closes the blades. The distal shaft is lightly knurled for easy grip. The pen can be autoclaved. In use it is dipped in ink to the level of the top of the slits if a lot of ink is needed, or not as deeply for more limited requirements, and the tip is wiped on the side of the ink container. Fine adjustment of the width of the line drawn can be made by altering the pressure with which the pen is applied to the skin. DISCUSSION The pen functions well with Bonney’s blue or any relatively low viscosity dye. The strong construction withstands all normal trauma. Its adjustable four-point tip gives
FIG. I.
Left,
the range
of lines which
can be produced. Right, a magnified pen showing how it is adjusted. I39
view of the end and tip of the
BRITISH
140
JOURNAL
OF PLASTIC
SURGERY
clear consistent lines (Fig. I). The pen can be rotated during use and is effective at a wide range of angles to the surface, so that no attention has to be given to its position while marking. One dip in Bonney’s blue provides sufhcient ink for marking out most The pen is simple and relatively inexpensive and there are no operative procedures. parts which require replacement. I would like to thank Mr Roy Worpole for his assistance in the design of this instrument and the production of prototypes. My thanks are also due to the Photographic Department, The London Hospital, for the accompanying illustration. REFERENCES “Principles and practice of plastic BARXY, A. J., KAHN, S. and SIMON, B. E. (1964). surgery”, second edition, p. IO. McGraw Hill Book Company Ltd: New York. COMESS, M. S. and MASSON, J. K. (1957). New method of skin marking. Plastic and Reconstructive Surgery, 20, 83. New type of skin marking inks. PIustic and TAMERIN, J. A. and BORNSTEIN, L. A. (1950). Reconstructive Surgery, 6, 475. plastic and ReconstrucWEISS? J. A. (1947). Inking pens for skin marking in plastic surgery. true Surgery, 2, 91. The instrument
is being manufactured
by Downs
Surgical
Ltd.,
Church
Path, Mitcham
Surrey.