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Surgical marking in TKR with Methylene Blue vs Commercially available markers: Efficacy and infection!!


Presenting Author - Abhijit Sahu
Introduction: Methylene blue is a dark green odorless hygroscopic crystal, available for medicinal use in 0.5% and 1% solutions. It is used as a marking solution for tracing fistulae, sinus tracts and skin incisions. Commercially available sterile marker pens contain Gentian Violet and are sterilized with Gamma Radiation in the factory and dispensed in sterile packages. Aims & Objectives: The purpose of the study was to determine if these two skin marking modalities can cause any post-operative infection in Total Knee replacement surgeries. Also we studied if the marking caused any permanent tattooing and its effectiveness in helping wound closure at the end of the surgery. Materials and Methods: 150 patients of Knee replacement were operated from 2011 till 2015.All patients were scrubbed with Betascrub solution .The limb was painted with Betadine solution and kept for 5 min. After draping the limb marking was done and the limb was covered with Ioban drape. In 75 patients commercially available marker pen (Soni OfficeMate) was used. In other 75 patients Methylene blue was used. All patients were followed postoperatively for infection and tattooing. Results: There was no postoperative infection over a follow up period of one year in either of the groups. There was no deep tattooing in both the groups. The superficial skin markings had self-erased in both study groups within 3 weeks of surgery. Methylene blue markings appeared more robust and visible at the end of the procedure. The limitation of the study was that infection was monitored over clinical grounds and no skin swabs were sent for the same. Conclusions: Methylene Blue is a much more cost effective , easily available & sterilizable, modality of skin marking as compared to the marker pen. Skin markings at the end of the procedure was more visible with the methylene blue helping close the wound. There were no postop surgical site infection or permanent tattooing in both groups.