Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 6.16 The Mogen device in situ Step 3. Close the device, crushing the foreskin. Leave in the closed position for 3–5 minutes, to reduce the risk of bleeding. If the device is left too long it may be difficult to separate the foreskin to reveal the glans after the device is removed. Step 4. Cut off the foreskin on the outer side of the clamp with a scalpel (Fig 6.17). Open the device and remove. Fig. 6.17 The foreskin is cut flush with the clamp using a scalpel. The Mogen clamp device protects the glans from injury. Step 5. Manipulate the penis, using gentle pressure from the side, to allow the glans to emerge from under the crushed foreskin (Fig 6.18). This is an important step to ensure the foreskin heals below the level of the corona. In older infants (>60 days) it may be necessary to place some 5-0 simple sutures to approximate the edges. Infant and paediatric circumcision Chapter 6 - 18
Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 6.18 Liberating the glans after removing the Mogen clamp Step 6. Wrap a piece of petroleum-jelly-impregnated gauze loosely around the penis. Information for parents The parents of an infant or child who has had a circumcision using the Mogen clamp technique should be told that it is not necessary to use a dressing and the child can be looked after in the normal way, including normal washing and the use of nappies. Healing is usually complete after about one week. Bleeding is rare because the clamp crushes the edge of the foreskin. The parents should be told to come back to the clinic if: • the child appears to be distressed or in pain; • the child has fever; • the child does not wake for feeding as per his usual pattern; • there is any separation of the skin edges; • there is any unusual swelling or bleeding; • the child has any difficulties with urination; • the parents have any other worry about healing. Infant and paediatric circumcision Chapter 6 - 19
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Manual for Male Circumcision under Local Anaesthesia

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