A. Understanding Circumcision
Circumcision is the act of removal of part / whole prepuce of the penis with a specific purpose (Arif Mansjoer, 2000: 409).
B. Circumcision Indications
According to Arif Mansjoer (2000: 409) an indication of circumcision are:
1) Religion (for Moslem)
2) Social
3) Medical:
a) Fimosis (prepuce can not be pulled back or can not open)
c) Condyloma akuminata
d) Prevention of tumor (preventing the buildup of smegma which allegedly is karsninogenik)
C. Circumcision Contraindications
C. Circumcision Contraindications
According to Arif Mansjoer (2000: 409) a contraindication to circumcisions are:
1) Absolute: hipospadia, epispadia
2) Relative: blood clotting disorders (eg hemophilia), localized infection, generalized infection, diabetes mellitus.
D. Complications of Circumcision
According to Arif Mansjoer (2000: 409) a complication of circumcision are:
Bleeding, Hematoma and infection.
E. Circumcision Equipment
According to Arif Mansjoer (2000: 409) equipment for circumcision include:
1) Scissors network 1 pieces
2) Straight artery Clamp 3 pieces
3) Curved artery Clamp 1 pieces
4) Anatomical tweezers 1 pieces
5) Needle holder 1 pieces
6) Leather sewing needle 1 pieces
F. Circumcision Supplies
According to Arif Mansjoer (2000: 409) equipment for circumcision include:
1) Cotton
2) sterile gauze
3) Plaster
4) Sterile cloth with the hole in the middle (duk)
5) Syringe 3 ml or 5 ml
6) Thread plain cat gut size 3.0
7) Sterile gloves
8) Solution NaCl 0,9 % or aqua destilata
G. Circumcision Drugs
According to Arif Mansjoer (2000: 410) drugs for circumcision include:
1) Lidokain HCL 2% (without a mixture of adrenaline)
2) Solution antiseptik: Solution sublimate, povidon iodin 10% and alkohol 70%.
3) Antibiotic ointments (kloramfenikol 2% or tetrasiklin 2%)
4) Analgesik oral (antalgin or paracetamol)
5) Antibiotic oral (ampisilin/amoksisilin/eritromisin)
6) adrenaline 1 : 1000
H. Tahap-tahap Sirkumsisi
According to Arif Mansjoer (2000: 410) stages perform circumcision among others:1) Preparation of Operation
a) Preparation of patients. Before circumcision, we determine there are no contra indications for circumcision act. It is known by history and physical examination. From the history traced:
(1) History of hemostasis disorders and blood disorders.
(2) A history of drug allergy, especially local anesthetic agents, antibiotics, or other drugs.
(3) Penyakit yang pernah/sedang diderita, misalnya demam, sakit jantung, asma.
On physical examination, look for:
(1) Generalist status: fever, signs of physical stress, heart and lung disorders
(2) Status localist: hypospadias, epispadia, or other congenital abnormalities.
b) Preparation tools and medicines circumcision.
c) Preparation tools and life support drugs in case of anaphylactic shock.
2) Asepsis and antisepsis
a) Patients have been showered with clean genitals (his genital) with soap
b) Clean the genital area with 70% alcohol to remove the layer of fat.
c) Clean the genital area with povidone iodine 10% with cotton from central to peripheral circle outwards (sentrifigal) with the upper limit edge of the navel and the lower limit covers the entire scrotum.
d) Putting a hole in a sterile cloth
3) Local anesthesia
Used in local anesthesia using lidocaine 2%
a) Perform anesthesia blocks on n. dorsal penis by inserting the needle on the medial line under simpisis pubis to penetrate the Buck fascia (such as through the paper) injections of 1.5 ml, pull the needle a bit, stick back tilt right / left menenbus fascia and inject 0.5 ml respectively; do aspiration before injection to determine whether the needle tip is in the blood vessels or not. If blood is aspirated then move the needle tip position, aspirations again. When none is aspirated, masukanlah anesthetic substance
b) Perform anesthetic infiltration in the subcutaneous layer of the ventral penis is 0.5 to 0.75 ml for both sides.
4) Cleaning of the glans penis
Go to the glans penis to the penis exposed to corona sulcus. If there are adhesions, freed by clamping the artery or with sterile gauze. If there is smegma, wipe with a solution containing sublimat pads.
5) Check what has been effective anesthesia
You do this by doing the clamping area of the frenulum with a clamp.
6) Cutting and sewing
a) Attach clamps on prepusium in the direction at 6, 11, and 1 with the tip of the clamp reaches ± 1.5 cm from the corona sulcus of the penis. The goal is to guide actions and means dorsumsisi hemostasis.
b) Do dorsumsisi by cutting the skin on the dorsum of the penis along the 12 o'clock from distal to proximal up to 0.3 to 0.5 cm from the corona.
c) Attach by sewing stitches control limits so that the cutting edge of skin dorsomsisi next skin more easily and symmetrical....
d) Cut out a circle (action circumcision) starts from the dorsal to the seam point at 12 encircling the penis, leaving about 0.5 cm mucosa. On the side of the frenulum, cutting a V shape on the left and right clamps. Cutting should be symmetrical, and equal in length between the skin and mucosa.
e) Overcome bleeding arising there clothespin clamps, and then do the sewing with thread cutgut hemostasis.
f) Perform skin approximation sutures with mucosa suture left and right respectively glans usually 2-3 knots. The principle is to bring the edge of the edge of the skin and mucosa.
g) Sew mucosa distal frenulum (6 o'clock) with the number 8 or 0 sutures.
h) After sewing is finished, cut the frenulum mucosa distal from the previous stitching, and clean it with iodine and then give 10% chloramphenicol ointment 2%
7) Dressing
a) Use a gauze that has been smeared antibiotic ointment.
b) Do not get twisted when bandaged penis.
8) The provision of drugs
a) Analgasik oral (antalgin atau parasetamol)
b) Antibiotik oral (ampisilin, amoksisilin, eritromisin)
c) Provision of these drugs can be started 2-3 hours before circumcision
9) Suggested post-operative
a) Explanation of the patients or parents ..
b) Bandage was opened 4-5 days later with a soaked gauze rivanol.
c) If there is infection, antibiotic treatment is continued until the day into 6-7
I. Method of Circumcision
According Akbidyo (2007) there are several methods of circumcision, among other things:
1) Classical methods and dorsumsisi, classical methods have much left but still can we find in the countryside. The tools used are sharp bamboo sebilah / knife / razor blade. gris
The bong chopsticks aka circumcision paramedics immediately cut the foreskin with a sharp bamboo without anesthesia. The scar is sutured and immediately wrapped with gauze / bandages so the method is faster than most other methods. This method carries the risk of hemorrhage and infection, if not done properly and sterile. Classical methods and refined by the method Dorsumsisi, Khitan method is already used medical equipment standard and is a classic circumcision is still widely used today., Generally not sutured scars, although some experts circumcision has been modified by performing a local anesthetic and minimal seams to reduce the risk bleeding.
2) Standard methods of conventional circumcision, is the most widely used method to date, it is an dorsumsisi and refinement of the method is the standard method used by many doctors and paramedics (nurses). The tools used are all in accordance with medical standards and require special expertise to perform this method.
3) Bell method, the method is not done cutting the foreskin. Tip of the penis just pulled tightly so that looks like a bell, resulting in clogged blood circulation resulting in the end of this skin does not get the blood supply and become necrotic, death and later released his own. This method requires a long time, about two weeks.
4) Klamp method, this method Klamp principle is the same, namely the foreskin (prepuce) is clamped with a tool (mostly disposable) and then cut with a scalpel without having to do sewing.
5) Elektrokautery laser method, better known as "Circumcision Laser". This naming sesunnguhnya less precise because the tools used at all do not use lasers but use "element" is heated. Tool shaped like a pistol with two wires on the end plates which are interconnected. If the electricity, the metal tip will be hot and flushed. Element is used to cut red foreskin. Circumcision with this excess heat solder is fast, easy to stop the bleeding is mild and suitable for children under the age of 3 years in which the small blood vessels. After suturing the prepuce cut done and fixed with sterile gauze. For the healing process, compared with the conventional way it is relative because it depends on the use of sterilization equipment, process and hygiene pengerjaanya individuals who were circumcised.
No comments:
Post a Comment