# Circumcision - adequate anesthesia



## bethh05 (Mar 1, 2010)

Post Op Dx: Phimosis and balanitis xerotica obliterans

Procedure Performed: Plastics Operation on the penis

Description: After adequate anesthesia, the penis was prepped and drapped steriley. The foreskin could not be completely retracted. A phimotic ring was noted with complete closure of the foreskin. Unsing the straight Kelly clamp, a dorsal slit was performed. The patient preoperatively discussed a great concern for the amount of foreskin that would be left, so the clamp was placed just to the most proximal portion where the phimotic ring could be seen. The coronal sulcus was not visible, as it was completely obliterated by the phimosis  and BXO. Once the dorsal slit was performed, then it was incised with a curved iris scissors. The corona had to be reconstructed by creating a plane between the fused foreskin and the glans of the penis. This was performed circumferentially to the point which appeared to be coronal sulcus and the frenulum was taken down. The skin and subcutaneous tissue was then mobilized down to the proximal portion and the phimotic foreskin was removed circumferentially. A formal sleeve resection was now performed. It was more than just an excision of the phimotic skin circumferentially beginning at the area of the dorsal slit and moving ventrally to the frenulum. Any bleeding was fulgurated with electrocautery, using the Adson forceps to grasp pinch the bleeder elevated off  of the penis and then cauterize on a 30-watt setting. 

I was looking at 54164, but any help is appreciated!! Thank You


----------

