Biomedical Engineering – From Theory to Applications

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Biomedical Engineering – From Theory to Applications
8.2.3 Winkelmann Clamp
Inventor: Provisionally attributed to the German urological
surgeon Karl Winkelmann (1863–1925).
Primary patent: None traced
Patent priority date: None traced
Patient age range: Infant to mid-puberty, according to manufacturer.
Category: Bell clamp / scalpel guide
Fig. 6. The Winkelmann Clamp.
Procedure: Nominally the same as the Gomco clamp described above. Despite its ready
availability, the Winkelmann Clamp appears not to have been trialled in connection with the
search for devices suitable for campaigns of mass circumcision.
8.2.4 Plastibell
Inventors: Kariher, D.H. and Smith, T.W.
Primary patent: US3056407
Patent priority date: 18 May 1955
Patient age range: Full-term neonate to onset of puberty
Category: Ischaemic necrosis device using string ligature
Procedure: The Plastibell is a clear plastic ring with handle and has a deep groove running
circumferentially. The adhesions between glans and foreskin are divided with a
haemostat (artery forceps) or similar probe. Then the foreskin is cut longitudinally
starting at the distal end dorsally to allow it to be retracted so that the glans (the head of
penis) is exposed (Elder, 2007). The appropriately sized device is chosen and applied to
the exposed glans. The ring is then covered over by the foreskin. A ligature is tied firmly
around the foreskin, crushing the skin against the groove in the Plastibell. Then the excess
skin protruding beyond the ring is trimmed off, something that is possible using surgical
scissors rather than a scalpel. Finally, the handle is broken off. The entire procedure takes
5 to 10 minutes, depending on the experience and skill of the operator. The compression
against the underlying plastic shield causes the foreskin tissue to necrotize. The ring falls
off in 3 to 7 days leaving a circumferential wound that will heal over the following week.
Typically, the glans will appear red or yellow until it has cornified (Gee & Ansell, 1976;
Holman et al., 1995).