An ink surgical marker pen is damaging to tendon cells
Abstract
Objectives
Surgical marking during tendon surgery is often used for technical and teaching purposes. This study investigates the effect of a gentian violet ink marker pen, a common surgical marker, on the viability of the tissue and cells of tendon.
Methods
In vitro cell and tissue methods were used to test the viability of human hamstring explants and the migrating tenocytes in the presence of the gentian violet ink.
Results
The outcome of this study was that a constituent of the surgical marker pen causes cell and tissue death in culture, implying the same would occur in vivo.
Conclusions
This is a cause for concern when marking tendon during surgical procedures, as it may compromise healing and repair and potentially contribute to a poor outcome. The authors suggest that an alternative surgical marking procedure should be found, or that all marker pens should undergo testing on human tendon tissue in vitro prior to use.
References
- 1 American Academy of Orthopaedic Surgeons. Information statement: wrong-site surgery, 2008. http://www.aaos.org/about/papers/advistmt/1015.asp (date last accessed 14 March 2012). Google Scholar
- 2 NHS National Patient Safety Agency. Patient safety alert 06: correct site surgery, 2005. http://www.rcseng.ac.uk/media/medianews/Nationalpatientsafetyagency/ (date last accessed 22 June 2011). Google Scholar
- 3
Tatla TLafferty K . Making your mark again in surgery. Ann R Coll Surg Engl 2002;84:129–130. Google Scholar - 4
Granick MSHeckler FRJones EW . Surgical skin-marking techniques. Plast Reconstr Surg 1987;79:573–580. Google Scholar - 5
Ayhan MSilistreli OAytug ZGorgu MYakut M . Skin marking in plastic surgery. Plast Reconstr Surg 2005;115:1450–1451. Google Scholar - 6
Adams EQRosenstein L . The color and ionization of crystal-violet. J American Chem Soc 1914;36:1452–1473. Google Scholar - 7
Docampo RMoreno SN . The metabolism and mode of action of gentian violet. Drug Metab Rev 1990;22:161–178. Google Scholar - 8
Shibata YMidorikawa KKoga THonjo NNaito M . Chondrolysis of the glenohumeral joint following a color test using gentian violet. Int Orthop 2001;25:401–403. Google Scholar - 9
Ide TYoo SHKymionis GD , . Descemet-stripping automated endothelial keratoplasty (DSAEK): effect of nontoxic gentian violet marking pen on DSAEK donor tissue viability by using vital dye assay. Cornea 2008;27:562–564. Google Scholar - 10
Scott AKhan KMHeer J , . High strain mechanical loading rapidly induces tendon apoptosis: an ex vivo rat tibialis anterior model. Br J Sports Med 2005;39:25. Google Scholar - 11
Au WPathak SCollie CJHsu TC . Cytogenetic toxicity of gentian violet and crystal violet on mammalian cells in vitro. Mutat Res 1978;58:269–276. Google Scholar - 12
Thomas SMMacPhee DG . Crystal violet: a direct-acting frameshift mutagen whose mutagenicity is enhanced by mammalian metabolism. Mutat Res 1984;140:165–167. Google Scholar - 13
Claes SVerdonk PForsyth RBellemans J . The “ligamentization” process in anterior cruciate ligament reconstruction: what happens to the human graft?: a systematic review of the literature. Am J Sports Med 2011;39:2476–2483. Google Scholar - 14
Deehan DJCawston TE . The biology of integration of the anterior cruciate ligament. J Bone Joint Surg [Br] 2005;87-B:889–895. Link, Google Scholar - 15
Lui PZhang PChan KQin L . Biology and augmentation of tendon-bone insertion repair. J Orthop Surg Res 2010;5:59. Google Scholar
