AFTERCARE AND FOLLOW-UP
Acute complications from circumcision are rare; estimates range from 0.2% to 2%.1 Bleeding and infection are the most common. Thus, I advise the parents to seek medical attention if there is any active oozing or blood stains on the diaper greater than the size of a quarter. As the cut edge of the foreskin heals, a yellowish mucoid reaction may be seen; mention to parents that this is normal. However, if there is any question about whether something they see is pus, or if they notice a foul odor, they should bring the infant in for re-examination.
I discourage bathing until the day after the procedure. Lubrication of the penis with white petrolatum(Drug information on white petrolatum) will decrease friction against the healing foreskin. I emphasize the importance— after the initial healing phase—of gentle retraction of the remaining foreskin at diaper changes to prevent new adhesions from forming between the cut foreskin and the glans. At follow-up visits, I sometimes need to use pressure with gauze to expose the corona again. I warn parents that this is mildly painful.
Despite controversies regarding the benefits and risks of the operation and nuanced preferences in technique, circumcision is a fairly straightforward and quick procedure that continues to stand the test of time. Because it does leave a memorable mark on patients, learners may first want to practice using a simulation model. Models using either a pacifier or a cocktail wiener covered by a surgical glove finger have been described in the literature and may make for a fun workshop.7,8