Surgical Pearl: Adding Gentian Violet to Aluminum Chloride Aids in Differentiating Cotton-Tipped Applicators on Surgical Tray

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Aluminum chloride is a commonly used topical hemostatic solution in dermatologic surgery and is most frequently formulated as a 20% solution in alcohol. Aluminum chloride–saturated cotton-tipped applicators (CTAs) are lightly rolled onto fresh biopsy sites with perpendicular pressure until hemostasis is achieved. Hemostasis occurs by hydrolysis of hydrogen chloride, leading to the precipitation of proteins and subsequent coagulation of vessels.1 The topical solution is generally considered safe with minimal adverse reactions, although local irritation and delayed wound healing have been reported.
With many surgical instruments dispersed on the surgical tray, it can be difficult to recognize aluminum chloride–coated CTAs versus dry CTAs. Because aluminum chloride is mostly alcohol, it is conceivable that it could ignite if mistakenly used with electrosurgery. However, if a small amount of gentian violet is added to the bottle of aluminum chloride, the solution turns a pale lavender which allows the practitioner to more hastily and accurately identify the lavender aluminum chloride–coated CTAs (Figure 1). Occasionally, because of the acidic pH of aluminum chloride, the solution can turn yellow-green; whereas, at a less acidic pH (pH > 2.6), it retains its natural blue-violet color2 (Figure 2).
Gentian violet, also known as crystal violet, is sometimes used as a topical antimicrobial in cutaneous infections and chronic ulcers and a dye in surgical marking pens, for staining suture, and for highlighting structures on the skin. Gentian violet is available in a 0.5% and 2% solution and typically has a shelf life of 2 to 5 years.3 It is generally well tolerated with no tattooing of the skin reported; however, contact dermatitis, irritation, necrosis, and staining of clothing can occur.4 Although there was prior concern for carcinogenesis outside the United States, there have been no reported cancer cases after its use.5
With minimal adverse reactions, the helpful addition of gentian violet to aluminum chloride can increase the ease and safety of surgical procedures and improve hemostasis by allowing the surgeon to quickly identify the lavender CTAs on the surgical tray.
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