Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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at this period, and later in life the prepuce may become so adherentto the glans that the operation becomes no longer possible. Operation. The penis having been cleansed with iodine solution theprepuce is drawn down so that the line of section is level with or slightlybehind the corona; the skin being flaccid the prepuce is held with sinus-or circumcision-forceps directed down and forwards so that the undersurface is cut longer than the upper. The prepuce in front of the CIRCUMCISION 631 forceps is cut off with sharp scissors, and the sinus-forceps being removed,the remaining prepuce retracts round the corona. The inner or mucouslayer of the foreskin, thus exposed, is slit up with blunt-pointed scissors,carefully avoiding injury to the glans and urethra, and is stripped backto the corona, which is recognized by the collection of smegma around it.The mucous layer of the prepuce is then trimmed off, leaving a collarone-eighth inch wide round the glans ; any bleeding-points are tied, and
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Fig. 213. Circumcision. I, Penis in section, a, b, Line of removal of prepuce,c, Skin, d, Mucosa of prepuce. II, Prepuce secured with forceps. Ill, Skinof prepuce removed, mucosa still has to be cut away. IV, Suturing skin to mucosa around the corona. in the case of infants a single suture fixes the pointed end of the lowerpart of the skin to the frgenum and checks bleeding. In older patientsthe skin and collar of mucosa are united with interrupted sutures varyingin number with the size of the organ; continuous sutures should not beemployed or a condition akin to paraphimosis, from strangulation of theglans, may arise. The line of incision is dressed with a strip of gauzecovered with sterile boric ointment to prevent sticking, and this is changeddaily or when soaked with urine. If any signs of inflammation arise the 632 A TEXTBOOK OF SURGERY patient is placed in a hip bath of boric lotion or weak lysol twice daily.In adults painful matutinal erections are likely to cause trouble and b

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