Henna as a Durable Preoperative Skin Marker

For many surgical procedures skin marking is required well before surgery and induction of anesthesia. In some cases, the patient may need to be standing or sitting while the skin area is marked. Marking of perforators and varicosities in chronic venous diseases, marking of stoma sites for urinary or fecal diversions are some examples. The side of surgery should ideally be marked preoperatively to avoid wrong side surgery. Marks made with conventional marking pens fade or disappear with preoperative skin preparation, whereas marks made with henna paste, which is orange to dark brown in color, last for up to 3 weeks in spite of regular showers and skin cleansing, even with ethanol. This property of henna encouraged us to use it as a preoperative skin marker.

Henna paste was used as a preoperative skin marker in 250 patients. In 154 patients with chronic venous diseases, perforators and varicosities were marked during duplex scanning. Henna was used to mark the colostomy site in 28 patients with carcinoma of the rectum prior to abdominoperineal resection of the rectum (APR) (four of them laparoscopic APR) and the aspiration site in 11 patients with liver abscesses and 4 patients with pleural empyemas, under ultrasonographic (USG) guidance. In addition, henna was used to mark the correct side of surgery in 47 patients undergoing unilateral inguinal hernia surgery. Marking was done from 1 to 8 days before surgery.

The marking with henna was clearly visible in all the cases even after preoperative skin preparation with ethanol up to 8 days after application. There were no complications associated with the marking. All marks disappeared 4 weeks after application. In terms of successful execution of the desired procedure, the use of henna marking was successful in all the cases.

Henna is an ideal substance for use as a preoperative skin marker. It can be safely and effectively used as a marker for varicose vein surgery, ultrasound-guided identification of lesions, establishing the ideal site for stomas on the abdominal wall, and to identify the correct side of surgery. Markings made with henna are durable and do not fade with routine bathing or preoperative skin preparation. In most cases there are no associated complications. Henna is cheap, safe, and convenient, and indications for its use can be ubiquitous.