Tattoo preservation in upper limb surgery: current practice and a patient-centred decision algorithm

Area of Science:

• Orthopaedic Surgery
• Plastic Surgery
• Dermatology

Background:

• Tattoos are increasingly prevalent and often located at planned surgical incision sites, particularly in hand and upper limb surgery.
• The presence of tattoos over incision lines presents aesthetic and ethical challenges for surgeons.
• Current surgical practices and attitudes regarding tattoo preservation remain largely unexamined.

Purpose of the Study:

• To assess the current practices and attitudes of hand and upper limb surgeons when tattoos are present at planned incision sites.
• To evaluate surgeon preferences for incising through tattoos versus employing tattoo-preserving techniques.

Main Methods:

• An electronic survey was distributed to orthopaedic and plastic surgery-trained hand and upper limb surgeons.
• Respondents were presented with a standardized scenario of a tattoo over a distal radius fixation incision.
• Surgeons selected their preferred surgical approach, with specialty, seniority, and training level recorded.

Main Results:

• A total of 225 surgeons responded, with 78% being senior surgeons.
• The majority of surgeons (77%) indicated they would incise directly through the tattoo.
• Tattoo-preserving approaches, such as marginal incision (15%) or skin flap elevation (3.1%), were less frequently chosen.

Conclusions:

• Hand and upper limb surgeons predominantly opt for standard incisions that transect tattoos.
• Limited literature exists on this topic, despite potential aesthetic and psychological impacts on patients.
• The ART algorithm (Assess safety-Review size-Talk to the patient) is proposed to guide preoperative decision-making and patient discussions regarding incision placement over tattoos.