[ ARC forum 2 ]
Written by 42M at 08 Aug 2004 12:52:37: Re: Prepuceplasty: An alternative to circumcision
As an answer to: Prepuceplasty: An alternative to circumcision written by jack at 06 Aug 2004 23:34:32:
>I was doing some research on circ and found this site:
>http://www.cirp.org/library/treatment/phimosis/decastella/
>It describes another way to fix tight foreskin and mentions something about brideges:
>Technique
>"The operation is carried out as a day case under general anaesthesia. Using fine scissors, a short full thickness longitudinal incision is made in the end of the narrowed prepuce, on the dorsal aspect (Figure 1A). This must be in the midline, exactly opposite the ventral raphe, and extends just far enough backe to allew complete and easy retraction--a 'mini-dorsal slit'. Adhesions to the glans are broken down if present. The prepuce is draw forwards again and the inner and outer layers of skin sutured together transversely (Fig. 1B) to produce permanent widening of the opening, starting at the apex of the cut and using five to seven interrupted sutures of 0000 polyglycolic acid.
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> By incising the outer layer slightly farther than the inner, and adjusting the needle bites appropriately, the suture line can be turned outward so that contact between the two halves and subsequent BRIDGING, is prevented. The aim is to produce a supple scar with minimal fibrosis, so the skin edges should be accurately apposed and the sutures tied snugly rather than tightly.
> Postoperatively, no attempt is made at first to retract the foreskin fully, lest the healing scar be torn. The two sides of the suture line are gently separated in the bath daily to remove any exudate or decomposing urine and prevent BRIDGING. The parents are warned that the end of the foreskin will look puffy for a week or so--otherwise the patient is liable to receive an unnecessary course of antibiotics. The wound can be inspected after a few days to check for bridging by fibrinous adhesions, and in 3 or 4 months to confirm full retractability.
>Results
>Analysis of the first persons treated in this way, 20 years ago, confirms the usefulness of the procedure and reveals some limitations. Sixty consecutive childhood prepuceplasty operations performed between 1973 and 1976 have been reviewed. Age at operation ranged from 1 to 14 years (median age 5 years). All patients had organic narrowing of moderate or severe degree.
> The patients were nearly all see within the first week after operation. Fifty-seven patients were seen after 3 months, and most again at 5-8 years. In addition, 46 patients responded to a postal/telephone questionnaire in 1993 to determine if further surgery had been needed, if the prepuce retracted easily and if the owner was happy with the cosmetic appearance. In total, 55 patients were reviewed either at 5+ or 17+ years, or both.
>Four patients needed subsequent circumcision, at between 1 and 5 years after the prepuceplasty. Of these, three were noted initially to have extensively fibrosed foreskins which were never supple enough after the operations to allow easy retraction. The fourth experienced POSTOPERATIVE BRIDGING but falied to return for follow-up until the two halves of the incision had firmly joined, reproducing the phimosis.
> One patient who had an over generous prepuceplasty, amounting to a traditional dorsal slit, ended up with an appearance exactly like a circumcision.
> At the time of their latest follow-up, the remaining 50 patients had needed no further treatment, had easily retractable foreskins and were happy with the appearance (except for one who thought it looked 'dog-eared"). Functionally there were no adverse comments--rather the contrary."
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>Notice how they mention "POSTOPERATIVE BRIDGING ." Perhaps this could also explain what happend with Stu. There was still some adhesion left from childhood which had not yet broken off as it should have done and the surgeon didn't bother or didn't know that you can break it up. So he just cut along the attached edge and left it that way. Which means it might be a simple procedure to fix...wishfull thinking...
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>Jack.
>this might give some more answers, if you want to go to a library:
>
>Williams N, Kapila L. Complications of circumcision. Br J Surg 1993; 80: 1231-6.
I'VE SEEN THIS BEFORE WHEN I WAS RESEARCHING SOME TIME AGO. DOES ANYONE HAPPEN TO KNOW OF ANY CURRENT SURGEONS WHO HAE A TRACK RECORD IN THIS PROCEDURE?