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Indian Journal of Surgery, Vol. 67, No. 1, January-February, 2005, pp. 55-56 Letter To Editor Sutureless circumcision: Author's reply Sharma Pradeep Bharati Vidyapeeth Medical College and Hospital, Pune Code Number: is05014 Sir, I was glad to have comments from our colleagues and I wish to add my clarifications. 1. I agree that the procedure can be performed under local anaesthesia, in fact I have performed the procedure under the same in the older age group. I feel that penile block is better as there is no distortion of the prepuce which can occur with infiltration of the prepuce. The cuts would be smooth and regular if they are taken in normal uninfiltrated tissues and so would be the final scar. 2. Stay sutures were taken 90 degrees apart so that makes it 4 sutures at 3, 6, 9 and 12 o′clock position. I found that one rarely requires more than 4 stay sutures. Of course one can take any number of sutures to make the approximation easier. 3. The dressing was placed so that the hardened glue should not catch the undergarments and come off. 4. The frenulum is the last area to heal. This is due to its peculiar anatomy of being a tongue-shaped delicate tissue. The traditional U stitch (irrespective of whether it is catgut or polyglycolic acid) strangulates the tissue and hence the healing is invariably delayed. Haemostasis is the key point in this technique hence I use bipolar cautery. Even the frenular artery is cauterised with the bipolar cautery. 5. The glue took comparatively less time (average 5 min) compared to suture (varies between 8 to 15 min depending on whether it is interrupted or continuous suture. The literature also highlights the same.[1] Accurate approximation is a must whether one performs it by glue or sutures. 6. The tensile strength of the wound after glue application is as good as sutures.[2] As erection cannot separate the sutured wound it should not separate a glued wound. If the wound separates then it could be due to tissues being under tension or glue seeping in between the wound edges. References
Copyright 2005 - Indian Journal of Surgery |
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