Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 5.26 Several simple sutures are placed between the 12, 3, 6 and 9 o’clock mattress sutures Depending on the skin pigmentation, there may be a strong contrast between the colour of the penile shaft skin and the remaining mucosa. With time the exposed mucosal skin will become darker and the contrast less marked. Step 11. Once the procedure is finished, check for bleeding. If there is none, apply a dressing (see ”Dressing” at the end of this chapter). Surgical procedures for adults and adolescents Chapter 5-22
Male circumcision under local anaesthesia Version 3.1 (Dec09) Dorsal slit method of circumcision The dorsal slit method requires more surgical skill than the forcepsguided method. It is helpful to have an assistant present during the procedure, although it can be done without one. There is a risk that more skin is cut away from one side than the other, giving an asymmetric result. Nevertheless, the technique is widely used by general and urological surgeons throughout the world. It is the technique illustrated in the WHO manual, Surgical care at the district hospital. 1 Step 1. Prepare skin, drape and administer anaesthesia, as described above. Step 2. Retract the foreskin and remove any adhesions, as described above. Step 3. Mark the intended line of the incision, as described above. Step 4 (optional). Some surgeons prefer to mark the line of incision by making a very shallow incision using a scalpel. This is useful on a deeply pigmented man on whom it is difficult to see the line of the marking pen or dabs of gentian violet. Before making the shallow incision, check carefully that the incision line is level with the corona and that even amounts of skin are marked for removal from each side of the penis. The incision should be made just through the skin; it is very important not to cut too deeply and divide blood vessels (Fig. 5.27). One disadvantage of marking the line of incision with a scalpel is that there may be an increased risk of accidental injury to the surgical staff. In addition, a relatively inexperienced surgeon may cut too deeply. However, these risks must be balanced against the risk of a poor result of the circumcision operation if the marking is difficult to see and too much or uneven amounts of skin are removed. Surgical procedures for adults and adolescents Chapter 5-23
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Manual for Male Circumcision under Local Anaesthesia

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