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The perfect surgical marking instrument does not yet exist. The felt-tip surgical marking pencils are fine for preliminary surgical plans but the marks are soon lost with surface irrigation.
The dermal tattoo is the only mark that remains during the surgical procedures of rubbing and wiping blood and detritus from the wound. This marking is critical in preserving landmarks such as original scars or the vermillion border.
Tattooing methylene blue into the dermis with a sharp needle has long been employed as a surgical marker. The blood welling up through the needle puncture wound sometimes deters the surgeon from preserving a clear field for incision.
The use of the 2-cm caliper for dermal tattooing enables penetration and deposition of marking fluid into the dermis without the bleeding that accompanies the needle puncture. However, the smooth surface of the caliper point does not lend itself to retaining marking fluid. A simple
VACCHIONE TR. Dermal Marking. Arch Surg. 1978;113(2):222. doi:10.1001/archsurg.1978.01370140112029