Surgical record of circumcision 1 Indications for surgery: Children with phimosis have difficulty urinating due to narrow foreskin opening, or recurrent infections. Adults suffer from recurrent infections due to phimosis or prepuce. 2 Preoperative preparation: The night before and on the day of surgery, instruct the patient to clean the area. Those complicated by foreskin and balanitis need to use medicine and local soaking first. Wait until the inflammation subsides before performing surgery. 3 Anesthesia: local anesthesia or cavernosal anesthesia. Children need basic anesthesia. 4 Surgical steps: a Position: supine position. b Cleaning and disinfection: Clean the area with soapy water or salt water, and then disinfect with PVP iodine. People with phimosis need to use a syringe to inject the disinfectant into the foreskin sac for disinfection. c. Separation of adhesions: If the foreskin orifice is narrow and the foreskin and glans penis are adherent, first use hemostatic forceps to expand the foreskin orifice, then use two hemostatic forceps to pick up the middle of the dorsal edge, with the two forceps 0.2CM apart, and use a grooved probe to separate them. Adhesive until the glans penis is completely separated from the foreskin. Wash again. dDesign the incision: use hemostatic forceps to clamp the mesentery to lift the foreskin. Use the tip of a knife to make an incision on the outer plate of the foreskin 0.5 cm distal to the edge of the coronal sulcus, preparing it as a circumferential incision to prevent too much removal. e Dorsal incision: Use scissors to cut the inner and outer plates along the probe groove, and the inner plate of the foreskin should also be cut to 0.5cm away from the edge of the coronal sulcus. f Removal of the foreskin: Align the inner and outer plates of the foreskin, pull out the hemostatic forceps clamped on the dorsal and mesangial sides of the foreskin, and recheck whether the incision on the outer plate of the foreskin can be used as an incision. If appropriate, use curved scissors to cut off the excess right flap at an incision about 0.5cm away from the coronal sulcus, and then cut off the left flap. The foreskin strap can be left uncut or left a little longer. g. Stop bleeding: Retract the skin of the penis upward to stop the bleeding after exposing the blood spots. Pay attention to ligating the superficial dorsal vein of the penis in the middle of the dorsal side of the penis. h Suture: Use thin silk thread or catgut (4-0, 5-0, 6-0) to sew one stitch each on the back, abdomen, left and right side of the circular incision. Do not tie the knot too tightly to avoid strangulation when the tissue is edematous. skin. The suture should not be too short and should be reserved for fixing the dressing. Then sew 1-2 stitches between the two stitches. The needle should pass out close to the incisal edge. i Bandaging: Wrap Vaseline gauze around the foreskin incision, tie it with a long suture, and then wrap it with several layers of gauze. 5 Precautions during surgery: During circumcision, the blood vessels between the inner and outer plates often retract proximally and must be found and ligated, otherwise large hematomas may easily form. The foreskin should not be cut too much, otherwise painful penile erection will occur after surgery. Generally, the inner plate of the foreskin should be cut to about 0.5cm from the coronal sulcus, and the mesangium should not be left too small. 6. Postoperative treatment: Take oral sedatives before going to bed for 3-4 days after surgery to prevent penile erection, causing pain and bleeding. For example, tell the patient not to wet the gauze when urinating. 7 personal experiences: Be careful not to cut too much on the inner and outer plates, otherwise it will be very difficult to deal with the incisal edges. Don’t use too much, as it may cause postoperative hematoma. Do not use too thin sutures, preferably catgut, as there is no need to remove the sutures. Two methods of circumcision: Fu style--fix the 12 o'clock and 6 o'clock positions with two vascular forceps, lift them outward, and use one vascular forceps to clamp the overly long foreskin diagonally, mesangial side Leave more on the opposite side and less on the opposite side. Then use a scalpel to completely remove it. The advantage of this method is that the cutting edge is absolutely neat and bleeding is relatively less due to the clamping effect. The disadvantage is that there is no real 0.5CM left on the inner and outer plates, and the incision edge is oblique. The scalpel may injure the internal glans during resection. Zhang type - use four vascular forceps to clamp the 12, 3, 6, and 9 o'clock positions, and use a straight vascular forceps to clamp the foreskin that is too long on the dorsal side. Pay attention to clamping the inner and outer plates together to keep them. Deep pinch marks. After leaving an estimated 0.5cm between the inner and outer plates, use scissors to cut, first at the 12 o'clock position, then first on the right side and then on the left side to remove the excess foreskin. The advantage is that there is less bleeding when the dorsal incision is made, and the inner and outer plates are both 0.5cm. The alignment is better during suturing.