Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig 5.22 Horizontal mattress suture at the frenulum (6 o’clock position) When placing the frenulum suture, take care to align the midline skin raphe with the line of the frenulum (Fig. 5.23). A common error is to misalign the frenulum and the midline skin raphe, which results in misalignment of the whole circumcision closure. Fig. 5.23 Alignment of the midline skin raphe on the shaft of the penis and the line of the frenulum. Step 9. Place a vertical mattress suture opposite the frenulum, in the 12 o’clock position (Fig. 5.24). The suture should be placed so that there is an equal amount of skin on each side of the penis between the 12 and 6 o’clock positions. The technique of vertical mattress suture is shown in Fig. 5.6. Place two further vertical mattress stitches in the 3 o’clock and 9 o’clock positions (see Fig. 5.8). Surgical procedures for adults and adolescents Chapter 5-20
Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 5.24 Placing a vertical mattress suture in the 12 o’clock position It is helpful to leave a long end on the horizontal mattress suture at the frenulum (at the 6 o’clock position) and on the vertical mattress suture opposite (at the 12 o’clock position). The long ends of the sutures can be held by an assistant with artery forceps to stabilize the penis during suturing (Fig. 5.25). Fig. 5.25 Penis is stabilized by an assistant holding two artery forceps (arrows) attached to the long ends of the 6 and 12 o’clock sutures Step 10. After placement of the sutures at the 6, 12, 3 and 9 o’clock positions, place two or more simple sutures in the gaps between them. The technique of simple interrupted sutures is shown in Fig. 5.5. Surgical procedures for adults and adolescents Chapter 5-21
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Manual for Male Circumcision under Local Anaesthesia

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