- Email: [email protected]
A modified circumcision suture technique
A MODIFIED CIRCUMCISION
SUTURE TECHNIQUE
J. HERSH, M.D. Visiting Surgeon, Passavant HospitaI PITTSBURGH,
T
HE cIassica1 method of suture in the of circumcision is to apoperation the cut skin edge to the proximate
PENNSYLVANIA
cuticuIar bite in the everted skin, the suture being passed transverseIy on the inside of the everted skin edge and back
FIG. 2. PIacement
of the subcuticuIar mattress sutures at the midline dorsaIIy, at the frenum and at equaIIy spaced points on the IateraI aspect.
FIG. 1. Diagram demonstrating the subcutictdar mattress suture going from without inward through the trimmed edge of the mucous membrane and taking a transverse subcuticuIar bite on the inside of the everted skin margin, finalIy being brought from within outward through the mucous membrane. The arrows show the direction of the suture at the frenum.
trimmed mucous membrane by interrupted sutures penetrating these Iayers. OccasionaIIy, there resuIts a “sawtooth” skin margin, the resuIt of one or severa sutures cutting through the skin. Such a necrosis is more apt to occur when too Iarge a bite is incIuded in the Iigature. A perfect union of skin and mucous membrane may be obtained by using interrupted subcuticuIar mattress sutures, inserted first through the mucous membrane from without inward, then taking a sub-
FIG. 3. Sutures
tied and the ends Ieft Iong to be tied over a piece of Vaseline gauze.
again from 123
through the mucous membrane within outward. The sutures are
124
American Journd
of Surgery
Hersh-Circumcision
placed at the frenum and dorsa1 aspects, then used as tractors unti1 two such sutures are evenIy pIaced on each side of the midIine. The ends are tied and Ieft Iong, to be tied again over a strip of vaseIine gauze, which, when separating in a week or ten days, Ieaves an intact skin margin united to the mucous membrane. By pIacing the sutures on the inside of the cut skin margin and not bringing the Ioop through the entire thickness of skin, one secures a fine cosmetic appearance, which requires a minimum of postoperative attention. REFERENCES LANMAN, THOMASH. Indications and contraindications for circumcision in children. Boston Med. & S. J., Igo: 628-630 (ApriI) 1924. COGSWELL, H. D. A safe technique for circumcision. J. Indiana M. A., 28: 371-372.
Suture
VAN AUKEN, WILLIAM B. D. Infant circumcision* New York State J. Med., 29: 82 (Jan. 15) 1929. BANDLER. CLARENCE G. Circumcision. Am. J. Sura. 6: 455-457 (April) 1929. WALKER, W. W. EIectrosurgicaI circumcision. Am. J. Surg., 6: 103-105 (JuIy) rgzg. RAUSCHKOLB, JOHN E. Circumcision, its vaIue in the treatment for chancroida1 Iesions of the mate genitaba. Arch. Dermat. @ Sypbil., 21: 251-256, 1930. CANRIGHT, CYRIL M. A simple circumcision operative procedure. Cbina M. J., 45: 152-153, 1931. HARRIS, HYMAN H. A new instrument for the simplification of circumcision. M. J. @ Rec., 135: Ig5-xg6 (Feb. 17) 1932. BETTMAN, ADALBERT G. An exact technic for circumcision. West. J. Sur,q., Oh., & Cynec., 41: 220-221
(April) em,
FRIEDMAN. ALEXANDER. A modified method of circumcision: Ural. ti C&n. Rev., 38: 319-320 (May) 1934. BERTWISTLE, A. P. JuveniIe circumcision. CIinicaI and Iaboratory notes. Lancet., I : 85-86 (Jan. 12) 1935. HARRIS, H. H. Instruments and technica methods. Med. Rec., 140: 441-443 (Oct. 17) 1934. YELLEN, HIRAM S. BIoodIess circumcision of the newborn. Am. J. Obst. &‘ Cynec., 30: I&I47 (JuIy) 1935.
SUTURE TECHNIQUE
J. HERSH, M.D. Visiting Surgeon, Passavant HospitaI PITTSBURGH,
T
HE cIassica1 method of suture in the of circumcision is to apoperation the cut skin edge to the proximate
PENNSYLVANIA
cuticuIar bite in the everted skin, the suture being passed transverseIy on the inside of the everted skin edge and back
FIG. 2. PIacement
of the subcuticuIar mattress sutures at the midline dorsaIIy, at the frenum and at equaIIy spaced points on the IateraI aspect.
FIG. 1. Diagram demonstrating the subcutictdar mattress suture going from without inward through the trimmed edge of the mucous membrane and taking a transverse subcuticuIar bite on the inside of the everted skin margin, finalIy being brought from within outward through the mucous membrane. The arrows show the direction of the suture at the frenum.
trimmed mucous membrane by interrupted sutures penetrating these Iayers. OccasionaIIy, there resuIts a “sawtooth” skin margin, the resuIt of one or severa sutures cutting through the skin. Such a necrosis is more apt to occur when too Iarge a bite is incIuded in the Iigature. A perfect union of skin and mucous membrane may be obtained by using interrupted subcuticuIar mattress sutures, inserted first through the mucous membrane from without inward, then taking a sub-
FIG. 3. Sutures
tied and the ends Ieft Iong to be tied over a piece of Vaseline gauze.
again from 123
through the mucous membrane within outward. The sutures are
124
American Journd
of Surgery
Hersh-Circumcision
placed at the frenum and dorsa1 aspects, then used as tractors unti1 two such sutures are evenIy pIaced on each side of the midIine. The ends are tied and Ieft Iong, to be tied again over a strip of vaseIine gauze, which, when separating in a week or ten days, Ieaves an intact skin margin united to the mucous membrane. By pIacing the sutures on the inside of the cut skin margin and not bringing the Ioop through the entire thickness of skin, one secures a fine cosmetic appearance, which requires a minimum of postoperative attention. REFERENCES LANMAN, THOMASH. Indications and contraindications for circumcision in children. Boston Med. & S. J., Igo: 628-630 (ApriI) 1924. COGSWELL, H. D. A safe technique for circumcision. J. Indiana M. A., 28: 371-372.
Suture
VAN AUKEN, WILLIAM B. D. Infant circumcision* New York State J. Med., 29: 82 (Jan. 15) 1929. BANDLER. CLARENCE G. Circumcision. Am. J. Sura. 6: 455-457 (April) 1929. WALKER, W. W. EIectrosurgicaI circumcision. Am. J. Surg., 6: 103-105 (JuIy) rgzg. RAUSCHKOLB, JOHN E. Circumcision, its vaIue in the treatment for chancroida1 Iesions of the mate genitaba. Arch. Dermat. @ Sypbil., 21: 251-256, 1930. CANRIGHT, CYRIL M. A simple circumcision operative procedure. Cbina M. J., 45: 152-153, 1931. HARRIS, HYMAN H. A new instrument for the simplification of circumcision. M. J. @ Rec., 135: Ig5-xg6 (Feb. 17) 1932. BETTMAN, ADALBERT G. An exact technic for circumcision. West. J. Sur,q., Oh., & Cynec., 41: 220-221
(April) em,
FRIEDMAN. ALEXANDER. A modified method of circumcision: Ural. ti C&n. Rev., 38: 319-320 (May) 1934. BERTWISTLE, A. P. JuveniIe circumcision. CIinicaI and Iaboratory notes. Lancet., I : 85-86 (Jan. 12) 1935. HARRIS, H. H. Instruments and technica methods. Med. Rec., 140: 441-443 (Oct. 17) 1934. YELLEN, HIRAM S. BIoodIess circumcision of the newborn. Am. J. Obst. &‘ Cynec., 30: I&I47 (JuIy) 1935.