After a bris, I try to explain to parents what things will look like over the next few days, weeks, and months as the circumcision goes through its different stages of healing.
There is swelling, a reminder of what things look like before vs after, there are stages of healing, a couple of long-term reminders: the Chubby Baby Syndrome and the Fusion Challenge.
I often comment about the importance of using a marker to indicate where the edge of the foreskin is before circumcising. When this is done in advance of the bris, and when the mark is actually followed during the circumcision, the incision can be very even and beautiful (to quote a colleague who loves to use the word 'beautiful' to describe his work).
But what are we marking? Why can't a rough estimate be sufficient?
There is a very definite point where the foreskin ends, and that spot is where the skin of the shaft lies naturally beneath the outer edge of the glans/corona. A "beautiful" circumcision has all of the foreskin plus the membrane beneath it removed at exactly that spot.
However, owing to the reality that most circumcisions are not accompanied by a complete removal of the membrane beneath the foreskin, there is a benefit to removing a little more than just the foreskin, because leaving MORE skin plays a significant role in the Fusion Challenge, and especially in the Chubby Baby Syndrome (I get many questions from mothers who ask about the need to pull down the skin over the longer term. Depending on how the circumcision goes, this is an issue for some people, or may never be an issue at all.)
So let's say there is 100% shaft skin to leave behind. A good mohel will actually leave between 88-95% of the original shaft skin, since the remains of the membrane will make a proper fusion with the shaft skin and fill in the remaining 5-12 percent of the shaft as needed.
Without using the marker, the chances of removing 50% or more of original shaft skin are not unheard of. And the incision has a decent chance of being significantly unbalanced - one side having more skin removed than the other (a little uneven is not bad - these things have a tendency to heal nicely nonetheless). This form of operating is a tremendous disservice to any baby.
Being educated about circumcision takes a lot of guesswork out of the process. Best of luck to everyone!
Showing posts with label fusion. Show all posts
Showing posts with label fusion. Show all posts
Thursday, July 30, 2015
Monday, August 8, 2011
The Fusion Challenge
This is a topic which seems to come up every now and then, but since I've dealt with it twice in the past week, I write about it again. [Here is the original posting on this subject]
The two cases I dealt with in the past week were on babies who were circumcised by physicians, one two weeks ago and one 2 years ago. In both cases, the babies' parents were unaware of "why" the baby did not look circumcised. With no need to re-invent the wheel, I refer you to the post I linked before, where I explain how parents should deal with this to avoid it being a long-term problem.
When the skin on the shaft (especially since it may be a little more loose after the circumcision) is looking to settle down and get comfortable, it can easily sort-of-kind-of fuse itself to the edge of the glans, or even climb up on the edge of the glans.
THE GLANS SHOULD BE DISTINCT. YOU SHOULD SEE THE OUTER EDGE OF THE GLANS, AND IT SHOULD NOT BE FLUSH WITH ANY SKIN OF THE SHAFT.
As some babies develop, their body fat is deposited most heavily in the groin area. So it is not uncommon for the penis to seem as if it sinks in to itself. It is constantly being constricted inside the diaper, and the baby fat likes to swallow whatever might appear "extra."
In this case, the glans' rim sometimes appears to fall back into the shaft, but you can still see that there is a glans and a shaft.
There is a more extreme case, where the glans and shaft disappear entirely into the hole from which they may otherwise seem to emerge, and when you open the diaper, you only see a scrotum and a hole where the shaft should be.
Not surprisingly, this condition is called "The Disappearing Penis."
To avoid boring you with details (it is apparently a little more common, just people don't talk about it), I refer you to Dr Greene, where he more than adequately deals with all the possible scenarios.
The two cases I dealt with in the past week were on babies who were circumcised by physicians, one two weeks ago and one 2 years ago. In both cases, the babies' parents were unaware of "why" the baby did not look circumcised. With no need to re-invent the wheel, I refer you to the post I linked before, where I explain how parents should deal with this to avoid it being a long-term problem.
When the skin on the shaft (especially since it may be a little more loose after the circumcision) is looking to settle down and get comfortable, it can easily sort-of-kind-of fuse itself to the edge of the glans, or even climb up on the edge of the glans.
THE GLANS SHOULD BE DISTINCT. YOU SHOULD SEE THE OUTER EDGE OF THE GLANS, AND IT SHOULD NOT BE FLUSH WITH ANY SKIN OF THE SHAFT.
As some babies develop, their body fat is deposited most heavily in the groin area. So it is not uncommon for the penis to seem as if it sinks in to itself. It is constantly being constricted inside the diaper, and the baby fat likes to swallow whatever might appear "extra."
In this case, the glans' rim sometimes appears to fall back into the shaft, but you can still see that there is a glans and a shaft.
There is a more extreme case, where the glans and shaft disappear entirely into the hole from which they may otherwise seem to emerge, and when you open the diaper, you only see a scrotum and a hole where the shaft should be.
Not surprisingly, this condition is called "The Disappearing Penis."
To avoid boring you with details (it is apparently a little more common, just people don't talk about it), I refer you to Dr Greene, where he more than adequately deals with all the possible scenarios.
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