f. Check that prepuce is freed from entire surface of

glans. Complete separation if necessary.

11. Complete circumcision using method of choice.

a. Use of circumcision clamp

(1) Check clamp to ensure that all parts are present,

fit well, and are in good working order.

(2) Assemble clamp, ensuring that yolk (arm)

articulates correctly with baseplate.

(3) Draw prepuce backward gently to expose

entire glans penis.

(4) Break down all residual adhesions, and observe

position of meatus. If meatus is abnormal,

cease at this point.

(5) Sponge glans dry with gauze swabs.

(6) Select stud (bell) of adequate size (see C), and

place over glans (Fig. 47.4A).

(7) Pull prepuce over stud.

(a) Approximate edge of dorsal slit. (A sterile

safety pin may be used.)

(b) Observe amount of skin remaining under

baseplate for accuracy.

Proper placement of prepuce over stud

is essential. Pulling too taut may lead to

removal of excessive penile skin. Insufficient

tension may lead to incomplete circumcision.

(8) Place baseplate of clamp over stud (with pin

perpendicular to shaft of penis) so that prepuce

is sandwiched between them (Fig. 47.4B).

(9) Continue to pull upward on stud until entire

prepuce is drawn through baseplate and stud

engages with baseplate.

(10) Hook yoke (arm) of clamp under side arms on

shaft of stud and bolt firmly to baseplate, after

checking position of prepuce between stud

and baseplate (Fig. 47.4C).

(11) Remove safety pin.

(12) Wait 10 minutes.

Hemostasis is produced by pressure between

baseplate and rim of stud. If the clamp is

removed before 10 minutes has elapsed, wound

edge hemostasis may be inadequate. If significant bleeding occurs during the procedure,

remove the device and search for bleeding

vessel—avoid blindly placing sutures.

(13) Remove prepuce with scalpel held parallel to

and flush with upper surface of baseplate. Never

use electrocautery; however, use of an ultrasound dissection scalpel has been described as a

safe alternative to electrocautery (6).

(14) Loosen bolt on clamp and remove.

(15) Optional: Dress with loose, noncircumferential sterile gauze impregnated with Vaseline.

Gough and Lawton (7) have shown that the

addition of tincture of benzoin to the dressing

adversely affected wound healing and the

addition of topical antibiotic did not produce

better results than those achieved with ordinary paraffin gauze.