Accurate preoperative skin marking is important in determining
the quality of the final result in plastic surgery
operations.1,2 Various writing instruments, such as cottontipped
applicators, splintered tongue blades, toothpicks, and
surgical marking pens of various types, have been used to
mark the surgical sites.3 Among these methods, disposable
pens are the easiest and most practical method of skin marking.
1 The lack of tattooing,3 loss of effectiveness with repeated
sterilizations,4 and fading with skin scrubs are the prominent
drawbacks of these pens. Also, despite the presence of versatile
tips that can make precise, fine lines when the pen is
held vertically and broader lines when the pen is held at an
angle, our experience with the accuracy of sterile marker
pens is that even the smallest possible mark may be thicker
than desired. Such inaccuracies are especially important in
operations such as cleft lip repair and scar revision (e.g.,
W-plasty) of the face. The use of straight surgical needles or
sharp, pointed wooden sticks may solve this problem, but
their use may be cumbersome, since the applicator has to be
dipped into the ink pot repeatedly and generally an extra
hand is required to hold the ink pot.4 Therefore, in operations
where delicate marking is desired, we shape the tip of
the marker pen with a no. 11 blade and convert it into a much
thinner applicator (Fig. 1). We have been doing this for the
last few years and are satisfied with the accuracy.