dxy

Figure 5
Glansplasty is a key determinant of the final cosmetic outcome. Over the years my technique has developed, and currently begins with a 7–0 polyglactin suture through the epithelium at the desired point for the ventral lip of the meatus. A second 7–0 suture is placed subepithelially in this same location to further buttress the neomeatus and hopefully prevent partial dehiscence that would result in a larger than normal meatus. No attempt is made to secure the glans to the underlying neourethra. The remainder of glans approximation is then done using interrupted 6–0 polyglactin subepithelial sutures proximally to the corona. It is not necessary to place sutures through the epithelium of the glans, and I have seen a few patients develop suture tracks when a second layer was created.

Figure 6
Skin closures also use subepithelial 7–0 polyglactin sutures to minimize the risk of suture tracks. During circumcision the dorsal hood is incised down the midline to the level of the subcoronal collar of the inner prepuce. This point is sutured, and then the ventral shaft skin is approximated up the midline, simulating the normal median raphe. Excess skin is next excised and remaining edges sutured. When the foreskin is reconstructed the inner prepuce is first closed with interrupted sutures, then dartos is approximated, and finally the outer shaft skin is sewn, giving a three-layer closure. A Tegoderm dressing is applied and the stent is left open dripping into a diaper.