Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 6.5 Clamping the foreskin Open and remove the clamp then hold the foreskin with artery forceps on each side of the crushed area, at the 11 o’clock and 1 o’clock positions. Using scissors make a cut at the 12 o’clock position, through the crushed skin. Special care should be taken not to insert the artery forceps or scissors into the urethra. (Fig. 6.6). Fig. 6.6 The dorsal slit [NOTE TO ARTIST: Use Fig 6.10 without the suture] Step 3. Using scissors cut the foreskin free, following the previously marked circumcision line (Fig. 6.7). Some surgeons use the bell of the Plastibell as a guide. This has the advantage of protecting the glans but the disadvantage that a new Plastibell device is required each time. It may be necessary in older boys to trim the mucosal layer of the foreskin to 2–3 mm from the corona. If this layer is left too long, the suture line can slip back over the glans, constricting it and making it appear as if the foreskin has not been removed (“concealed glans”). Control any significant bleeding by clipping the blood vessel with an artery forceps and then tying. Bipolar diathermy may be used, if available. Minor bleeding can be controlled with simple pressure for five minutes. Infant and paediatric circumcision Chapter 6 - 10
Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 6.7 Removing the foreskin by cutting along the marked line of circumcision Step 4. Suture the edges of the incision with 5/0 or 4/0 vicryl or catgut sutures (depending on the age of the child) and a roundbodied needle. Cutting needles should not be used. Approximate the skin edges and the frenulum using simple sutures; mattress sutures are not necessary. Take great care at the frenulum, because the urethra is near the surface and can easily be injured by too deep a bite. Place all sutures approximately 1 mm from the skin edge. Place the first two sutures at the 12 o’clock and 6 o’clock positions, leaving them long and temporarily held with forceps (Fig. 6.8). This keeps the penis stable while the remaining sutures are completed. In babies, only two further stitches may be needed on each side. In older children, it is helpful to place sutures at the 3 o’clock and 9 o’clock positions, and then to place the final sutures in between. Fig. 6.8 Suturing the circumcision wound. Finally, inspect the wound and apply a piece of gauze impregnated with petroleum jelly or with petroleum jelly plus antibiotic. Infant and paediatric circumcision Chapter 6 - 11
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Manual for Male Circumcision under Local Anaesthesia

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