Here is one example of what a degloving circ looks like. Is this what we are talking about here? This is one that was done by Mogen. Excessive force squeezing the foreskin through the Mogen slit was the likely mechanism.
Wm MacMillan Rodney MD, FAAFP, FACEP
Adjunct Professor of Family Medicine
Medicos para la Familia
Memphis, Nashville and rural Tn.
In response to the following (wmr):
I write because ....unknowingly had a cuff of the foreskin folded back under itself over the bell. The result was a "ring of the treebark" with the under lying mucosal surface not cut through. It was discovered the following morning on rounds. The distal skin was intact and healthy. Urology and plastics resutured the cut edges of the outer skin and cut a small dorsal slit to relieve pressure. All appears to be healing well now.
....... have never before seen this complication, but admit I do not recall seeing it in print. Was wondering if any of your proceduralists have done it this way or if you know of a reference. We utilize the procedure for stretching and retraction with the Mogan clamp routinely, without a dorsal slit.
David A. McClellan, MD
Program Director, Progra Family Medicine Residency
Jack Pfenninger wrote:
Hi David…I have seen the squamous epithelium “skinned off” the mucosal tissue several times if that’s what happened, and it happens even with the dorsal slit. Not sure if anyone does the circs without the dorsal slit. Will send it out for a response! If so, maybe we’ll have to print it up as a variation in the circ chapter!!
NEXT COMMENT CAME FROM Paul W. Davis,MD:
Chair, Dept of Family Medicine, PAMC;Director of Surgical and Procedural
Training Alaska Family Medicine Residency[Associate Clinical Professor
University of Washington School of Medicine[President, Alaska Academy of
I think that I can visualize what happened from the description. I have never done a circ without a dorsal slit (and have done many ‘freehand’ circs on older children and adults using just scalpel, cautery, and interrupted sutures after the dorsal slit). I would theoretically think that with the tight neonatal physiologic phimosis, stretching the foreskin would be tougher than just cutting the DS. In addition, I think that you get a better view & can review your work before trimming off the excess foreskin if a DS has been cut.
I suspect that the ventral prepucial foreskin got ‘hung up’ on the edge of the Gomco bell while pulling it forward again after placing the bell and base. This the ventral forskin is hidden in your approach, the redundancy was not seen. In any event, it’s no “biggie”, easy to correct, no significant or permanent sequelae.
Jack and Dave:
Two or three times in the last 10-11 years I was call because "we do not know what to do" and there was the near intact "fold" of mucosa over the glans. Always with Dorsal Slit. I cut it after I stretch it with 2 hemostats and do hemostasis. The first I asked one of the urologist if I "have to call" and he refused. "it will heal fine" answer as always.
The few that I assist fellow attendings where always with Gom-co. They looked much more "even" and smooth than this. I agree with Paul that you do it as an "older" Circ.