Manual for Male Circumcision under Local Anaesthesia

More documents

Recommendations

Info

Male circumcision under local anaesthesia Version 3.1 (Dec09) Fig. 4.9: Phimosis (www.netterimages.com, #1468, with permission) Fig. 4.10 Paraphimosis (www.netterimages.com, #1468, with permission) Facilities and supplies and preparation for surgery Chapter 4-22
Male circumcision under local anaesthesia Version 3.1 (Dec09) Chapter 5 Surgical procedures for adults and adolescents SUMMARY This chapter gives step-by-step instructions for performing a circumcision on an adult or an adolescent. It covers tissue handling, skin preparation, local anaesthesia, the circumcision itself, suturing, and dressing the wound. Three surgical techniques are described: • the forceps-guided method; • the dorsal slit method; • the sleeve resection method. SURGICAL SKILLS REQUIRED FOR SAFE CIRCUMCISION Anatomy of the penis and choice of surgical technique It is important to have a good understanding of penile anatomy before undertaking male circumcision. This is described and illustrated in detail in Chapter 4 and Appendix 4.3. Variations in technique for minor abnormalities of the foreskin are described in Appendix 5.1. Three widely-used surgical techniques for adult and adolescent circumcision are described in detail in this chapter. They have been selected on the basis of extensive experience worldwide, as well as the results from three randomized controlled trials of circumcision in Kenya, South Africa and Uganda. It is not recommended that a nursing, clinical or medical officer learn all three surgical techniques – it is best to become a master of one adult technique and, if appropriate, one paediatric technique. This will produce the best results with the least complications. Providers should become expert in the technique most suited to the circumstances of their practice or the preferred technique adopted nationally. All three recommended techniques are fully illustrated and can be referred to in the context of a training course. After the training the illustrations and step-by-step guide can be used to reinforce what has been learnt and for retraining. Experienced surgeons should be able to perform all three techniques with little difficulty, and to train less experienced providers in any of the three techniques described. Tissue handling The surgeon should handle tissue gently. Unnecessary crushing of tissue causes more scarring, delays healing and increases the risk of infection. Use dissecting forceps (tweezers) to hold the skin edge when suturing the circumcision wound; do not use artery forceps. Place haemostatic sutures accurately, taking care to avoid inserting the needle too deep into the surrounding tissue. Surgical procedures for adults and adolescents Chapter 5-1
Page 1:
Male circumcision under local anaes
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13:
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31: Male circumcision under local anaes
Page 79: Male circumcision under local anaes
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185:
Page 190:
For more information, please contac
show all

Manual for Male Circumcision under Local Anaesthesia

Create successful ePaper yourself

Delete template?

Save as template?