Protecting your Perforator Markings

Recent techniques in preoperative planning and localization of suitable deep inferior epigastric perforators for free flap reconstruction using hand held Doppler, computed tomography, or magnetic resonance angiogram have been shown to improve surgical outcomes. The marking of identified perforators onto the abdomen before surgery increases a microsurgeon's confidence in targeting their approach in the midst of a difficult dissection.[1]

However, the use of surgical pen markers during the markup of the perforator grid can create confusion, especially when raising the abdominal flap as the ink fades following application of skin preparation and rigorous tissue handling during surgery. The authors find that remarking the skin intraoperatively becomes difficult and often creates delays due to the presence of blood and fluid. This problem is consistent with previous surgical experience.[2]

This was solved with the use of a transparent waterproof dressing (Tegaderm, 3M Healthcare, Borken, Germany). The perforators were identified and marked preoperatively onto the patient's abdominal skin. Following skin preparation at time of surgery, the partially washed out markings were remarked and covered with Tegaderm ([Fig. 1]). The transparent dressing allowed constant visualization of the perforator areas marked, while allowing uninterrupted tissue handling and “washing off” of blood without the risk of removing the prepared markings due to its adhesive and waterproof qualities. This technique is ideal and highly recommended[3] compared with the potential permanence and cosmetic appearance of surgical tattooing; as both dressing and ink can be easily removed at the end of dissection.

Fig. 1 A transparent waterproof dressing (Tegaderm, 3M Healthcare, Borken, Germany) is applied over the perforator markings following skin preparation before incision, which protects the ink from fading due to tissue handling and the “washing off” from blood and fluid present during surgery.

Note

This article has not been submitted or presented at any meetings.

• References

• 1 Tillet RL, Rees Lee JE, Jones L, Wilson SM. Improving the accuracy of intraoperative perforator location in DIEP flaps. J Plast Reconstr Aesthet Surg 2014; 67 (2) e60-61
• 2 Tatla T, Lafferty K. Making your mark again in surgery. Ann R Coll Surg Engl 2002; 84 (2) 129-130
• 3 Bong JJ, Lansdown M. Tegaderm technique to protect skin marking. Ann R Coll Surg Engl 2003; 85 (1) 62