Art, pharmacy and history of skin marking and surgical inks in plastic surgery

Abstract

Plastic surgeons can be distinguished in pre-planning much of their surgery by drawing on the skin. The history of marking the body with ink in plastic surgery goes back to the 1400s. The Sommerlad pen was originally developed at the London Hospital in the 1970s. Sommerlad pens and Bonney’s blue ink allow for a consistent weight of the pen in hand, a reliable source of ink, and an ability to vary the thickness of the line drawn. There has been a suspicion that gentian violet, a component of Bonney’s blue ink, is a carcinogen, resulting in supply problems. Animal models have demonstrated the carcinogenic properties of gentian violet, but evidence to support the carcinogenic potential of gentian violet in humans is sparse. In the surgical setting, we must adhere to using published and described ink formulas. Proprietary formulations lack standardisation, and the compounds used are not always disclosed. The concerning findings of in-vitro and animal models are a valuable addition to our knowledge about these compounds; however, to over-extrapolate and restrict its use on humans as a topical skin marker takes away an important component of a plastic surgeon’s armamentarium.