The Application of Henna (Lawsonia inermis) in Orthopedics

Background: Many orthopedic procedures require skin marking as part of preoperative planning. The markings obtained from commercially available permanent pens may fade away after vigorous skin preparation before surgery. We describe the use of Henna (Lawsonia inermis) paste as a durable, readily available, and cost-effective material for preoperative skin marker in various orthopedic surgeries. Patients and Methods: We performed a retrospective review of prospectively collected data of 50 cases with various indications of preoperative localization of skin incision and divided them in 2 groups: Group A (n=25) were the patients where Henna was to be used as marker and group B (n=25) were the ones where permanent skin marking pen was decided to be used for the purpose of skin marking. The groups were compared for the instances of mark fading after bathing, after scrubbing of surgical part, the need for intraoperative fluoroscopy, and complications because of marking substance. Results: Of the 25 cases where henna was used for markings (group A), none had fading of mark after routine bath with soap on the morning of surgery (0 of applicable 11) or after surgical scrubbing (0 of 25). However, for the permanent marker (group B), 3 patients (of applicable 6) had fading of mark beyond recognition after routine bath with soap and additional 10 cases (of applicable 22) had fading of mark beyond recognition after surgical scrubbing (P<0.05). Four cases (of applicable 23) from group A still required intraoperative fluoroscopy, whereas this figure was 15 (of 25 cases) for group B (P<0.05). There was no suggestion of rash/allergy/wound infection in either group. Conclusions: Henna paste may reliably be used in various orthopedic procedures like foreign body removal, vertebral-level identification, nail dynamization, marking growth plate in children, identification of sequestrum in nondischarging chronic osteomyelitis, and marking the course of blood vessels in tumor surgery.