Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) there is a risk of inversion (burying) of the skin edges and poor healing. For this reason, in male circumcision, a combination of simple and mattress sutures is recommended. A B Fig. 5.5 Simple interrupted suture. A: suture in place holding the skin edges together. B: simple sutures closing the circumcision incision. Mattress sutures. Mattress sutures give a more precise apposition of the wound edges and reduce the risk of burying the skin edges. They are more complex than simple interrupted sutures, and therefore more time-consuming to put in. Vertical mattress suture The technique is illustrated in Fig. 5.6. 1. Start the first bite wide of the incision and pass to the same position on the other side of the wound. 2. Start the second bite on the side of the incision where the needle has just exited the skin. Pass the needle through the skin between the exit point and the wound edge, in line with the original entry point. From this point, take a small bite; the final exit point is in a similar position on the other side of the wound. 3. Tie the knot so that it does not lie over the incision line. This suture approximates the subcutaneous tissue and the skin edge. When suturing the circumcision wound, vertical mattress sutures are usually placed in the 12 o’clock, 3 o’clock and 9 o’clock positions (taking the frenulum as the 6 o’clock position). Surgical procedures for adults and adolescents Chapter 5-6
Male circumcision under local anaesthesia Version 3.1 (Dec09) A B C D Fig. 5.6 Vertical mattress suture. A, B: the technique. C: vertical mattress suture holding the skin edges and subcutaneous tissues together. D: A vertical mattress suture in the 9 o’clock position. Horizontal mattress suture The technique is illustrated in Fig. 5.7. 1. Make two sutures, aligned beside one another. Align the first stitch across the wound; begin the second on the side that the first ends. 2. Tie the knot on the side of the original entry point. A horizontal mattress suture is placed in the 6 o’clock position (frenulum). A B C D Fig. 5.7 Horizontal mattress suture. A, B, C: the technique. D: A horizontal mattress suture at the frenulum (6 o’clock position). Surgical procedures for adults and adolescents Chapter 5-7
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Manual for Male Circumcision under Local Anaesthesia

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