Circumcision injuries, complications, pain

Below are excerpts and links. The links are in blue.
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Elma cream not indicated for use on newborns or the genital area of a child under a year old

emla information insert
Use on the skin prior to procedures such as needle insertion and minor skin surgery
(adults and children older than 1 year):

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injuries

Genitourinary injuries in the newborn.

Authors
Patel HI, Moriarty KP, Brisson PA, Feins NR.
Journal
J Pediatr Surg. 2001 Jan;36(1):235-9.

Affiliation
Division of Pediatric Surgery, The Floating Hospital for Children, Boston, MA, USA.

Abstract
BACKGROUND: Circumcisions and cesarian sections are common procedures. Although complications to the newborn child fortunately are rare, it is important to emphasize the potential significance of this problem and its frequent iatrogenic etiology. The authors present 7 cases of genitourinary trauma in newborns, including surgical management and follow-up.

METHODS: The authors relate 7 recent cases of genitourinary trauma in newborns from a children’s hospital in a major metropolitan area.

RESULTS: Case 1 and 2: Two infants suffered degloving injuries to both the prepuce and penile shaft from a Gomco clamp. Successful full-thickness skin grafting using the previously excised foreskin was used in 1 child. Case 3, 4, and 5: A Mogen clamp caused glans injuries in 3 infants. In 2, hemorrhage from the severed glans was controlled with topical epinephrine; the glans healed with a flattened appearance. Another infant sustained a laceration ventrally, requiring a delayed modified meatal advancement glanoplasty to correct the injury. Case 6: A male infant suffered a ventral slit and division of the ventral urethra before placement of a Gomco clamp. Formal hypospadias repair was required. Case 7: An emergent cesarean section resulted in a grade 4-perineal laceration in a female infant. The vaginal tear caused by the surgeon’s finger, extended up to the posterior insertion of the cervix and into the rectum. The infant successfully underwent an emergent multilayered repair.

CONCLUSIONS: Genitourinary trauma in the newborn is rare but often necessitates significant surgical intervention. Circumcision often is the causative event. There has been only 1 prior report of a perineal injury similar to case 7, with a fatal outcome.

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warning of injuries

This letter is to alert you to the potential for injury from two commonly used circumcision clamps, the Gomco®/gomco-type and Mogen®/mogen-type clamps. Both are widely used during circumcision to remove the foreskin while protecting the glans penis.
Although research suggests that circumcision is generally a safe procedure, we are concerned that some serious device-related complications have occurred. We received 105 reports of injuries involving circumcision clamps between July 1996 and January 20001. These have included laceration, hemorrhage, penile amputation, and urethral damage.
We are providing recommendations below that can help avoid these complications.

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pain meds not truly effective in many infant circumcisions

RESULTS: Dorsal nerve blocks were judged to be fully effective in over 70% of cases. Neither Mogen nor PlastiBell was associated with greater pain per 3-minute time period, but the PlastiBell technique on average took nearly twice as long as the Mogen procedure (20 vs 12 minutes). We judged that 60% of the infants had pain or discomfort associated with the procedure that was excessive. Residents and interns universally preferred the Mogen technique over the PlastiBell because of the former’s simplicity.

Pain, discomfort, and behavioral changes are well documented during neonatal circumcision;9,10,11,12 however, there are few studies comparing methods and procedures used for circumcisions.13 In this study, we measured duration and intensity of pain with a simple behavioral scale after randomizing infants to one of two techniques ¾ Mogen or PlastiBell. Our presumption was that the procedure of shortest duration would be the least painful granted the amount of pain per unit time was similar with each technique. Although circumcision is usually a rapid procedure in the hands of skilled operators,13 no studies have compared the amount of time required by trainees to perform different techniques.

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plastibell complication with pic

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sigh….

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circumcision complications with photos

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pictures of the procedure of circumcision and pics of some complications

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pictures of the plastibell being done

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vocabulary of circumcision

——– in the end it doesn’t matter if almost all circumcisions on children come out without complication. It doesn’t matter if it is mostly safe. What if it is your child with the complication? What if it is your child that is seriously harmed? These are elective surgeries… ELECTIVE, which means one serious complication is one too many on an u consenting, healthy, innocent, helpless child.

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