Surgical foreskin restoration: Difference between revisions
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}}</ref> Celsus was not himself a doctor, so it is possible that ''On Medicine'' (which was once part of a much larger encyclopedia) is a translation of an earlier Greek text. | }}</ref> Celsus was not himself a doctor, so it is possible that ''On Medicine'' (which was once part of a much larger encyclopedia) is a translation of an earlier Greek text. | ||
Surgical foreskin reconstruction has remained largely unchanged since Celsus first described the procedure 2000 years ago. An incision is made around the base of the penis and the penile shaft is denuded (in other words, the skin is peeled off), leaving the shaft skin attached only beneath the glans penis. This skin is then pulled forward to replicate a foreskin. To tighten the new foreskin and improve its contour, a wedge-shaped section may be removed and the opening sutured shut. Skin is then harvested from the scrotum and grafted onto the penis to patch the missing shaft skin. This is performed as a series of three operations, followed by several sessions of electrolysis to kill the hair follicles in the grafted scrotal skin. | Surgical foreskin reconstruction has remained largely unchanged since Celsus first described the procedure 2000 years ago. An incision is made around the base of the penis and the penile shaft is denuded (in other words, the [[skin]] is peeled off), leaving the shaft [[skin]] attached only beneath the glans penis. This [[skin]] is then pulled forward to replicate a foreskin. To tighten the new foreskin and improve its contour, a wedge-shaped section may be removed and the opening sutured shut. [[Skin]] is then harvested from the scrotum and grafted onto the penis to patch the missing shaft [[skin]]. This is performed as a series of three operations, followed by several sessions of electrolysis to kill the hair follicles in the grafted scrotal [[skin]]. | ||
Celsus described two methods, the above method mostly for children with naturally short [[foreskin]], and a different method for patients circumcised after the customs of certain races. | Celsus described two methods, the above method mostly for children with naturally short [[foreskin]], and a different method for patients circumcised after the customs of certain races. | ||
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According to the literature, there were Polish doctors who devised hasty, crude surgical techniques to help Jews in occupied areas of Europe avoid detection. Some of these procedures were surprisingly reminiscent of those described by Celsus nearly 2000 years earlier. There is no evidence that any of these methods was continued after the collapse of the Nazi regime.<ref name="schultheiss1998" /> | According to the literature, there were Polish doctors who devised hasty, crude surgical techniques to help Jews in occupied areas of Europe avoid detection. Some of these procedures were surprisingly reminiscent of those described by Celsus nearly 2000 years earlier. There is no evidence that any of these methods was continued after the collapse of the Nazi regime.<ref name="schultheiss1998" /> | ||
Feriz performed several operations on circumcised patients in occupied Holland. After a circumferential incision at the base of the penis the penile skin was pulled over the glans, forming the new prepuce. The proximal skin defect was then covered by burying the penis under a tunnel of ventral scrotal skin. In a second stage operation about 10 days later he mobilized the penis and closed the new skin layer at the underside of the penis. The scrotal defect was easily closed in all cases. In his publication from 1962, Feriz reported no complications, and all of his patients were satisfied with the postoperative result; none of them requested a reversal of the surgery after the war.<ref name="schultheiss1998" /> | Feriz performed several operations on circumcised patients in occupied Holland. After a circumferential incision at the base of the penis the penile [[skin]] was pulled over the glans, forming the new prepuce. The proximal [[skin]] defect was then covered by burying the penis under a tunnel of ventral scrotal [[skin]]. In a second stage operation about 10 days later he mobilized the penis and closed the new [[skin]] layer at the underside of the penis. The scrotal defect was easily closed in all cases. In his publication from 1962, Feriz reported no complications, and all of his patients were satisfied with the postoperative result; none of them requested a reversal of the surgery after the war.<ref name="schultheiss1998" /> | ||
In 1965, Tushnet reported three different procedures to restore the prepuce depending on the age of the patient, the remaining preputial skin, and the skill of the surgeon.<ref name="tushmet1965">{{REFjournal | In 1965, Tushnet reported three different procedures to restore the prepuce depending on the age of the patient, the remaining preputial [[skin]], and the skill of the surgeon.<ref name="tushmet1965">{{REFjournal | ||
|last=Tushmet | |last=Tushmet | ||
|first=Leonard | |first=Leonard | ||
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== Modern foreskin restoration == | == Modern foreskin restoration == | ||
Since the 1970s a new movement of [[foreskin restoration]] has emerged mainly in the United States not originating from social, religious, or political demands. With non-therapeutic male infant circumcision being well established in America, more and more adult circumcised males are disturbed by the fact that the shape and function of their body had been altered after birth. Their main complaint is the loss of function; the prepuce is not just seen as a part of the human skin but referred to as a [[Foreskin#Sensory_functions| sensory organ]] of the body.<ref name="sorrells2007">{{Sorrells etal 2007}}</ref> Circumcision results in a lack of this organ and furthermore in a decrease of lubrication and sensibility of the glans because of increasing keratinization of the epithelium. Others are disturbed by the outer appearance of their circumcised penis and want to regain the natural status of a covered glans for physical and emotional wholeness and aesthetic body imaging. Some are additionally irritated by the feeling of being mutilated as an infant without the chance to have a free choice of their genital status. A high percentage of these patients even resent their parents, doctors, or culture for their circumcision.<ref name="schultheiss1998"/><ref name="watson2017">{{REFjournal | Since the 1970s a new movement of [[foreskin restoration]] has emerged mainly in the United States not originating from social, religious, or political demands. With non-therapeutic male infant circumcision being well established in America, more and more adult circumcised males are disturbed by the fact that the shape and function of their body had been altered after birth. Their main complaint is the loss of function; the prepuce is not just seen as a part of the human [[skin]] but referred to as a [[Foreskin#Sensory_functions| sensory organ]] of the body.<ref name="sorrells2007">{{Sorrells etal 2007}}</ref> Circumcision results in a lack of this organ and furthermore in a decrease of lubrication and sensibility of the glans because of increasing keratinization of the epithelium. Others are disturbed by the outer appearance of their circumcised penis and want to regain the natural status of a covered glans for physical and emotional wholeness and aesthetic body imaging. Some are additionally irritated by the feeling of being mutilated as an infant without the chance to have a free choice of their genital status. A high percentage of these patients even resent their parents, doctors, or culture for their circumcision.<ref name="schultheiss1998"/><ref name="watson2017">{{REFjournal | ||
|last=Watson | |last=Watson | ||
|first=Lindsay R. | |first=Lindsay R. | ||
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In 1981, Mohl presented the first detailed analysis of psychiatric aspects in a group of eight patients seeking prepuce restoration. He described several psychological disorders in these patients as narcissistic and exhibitionistic body image, depressions, major defects in early mothering, and ego pathology. Nowadays the understanding of the psychological motivations for uncircumcision is increasing, and the problem is dealt with more seriously.<ref name="watson2017" /> | In 1981, Mohl presented the first detailed analysis of psychiatric aspects in a group of eight patients seeking prepuce restoration. He described several psychological disorders in these patients as narcissistic and exhibitionistic body image, depressions, major defects in early mothering, and ego pathology. Nowadays the understanding of the psychological motivations for uncircumcision is increasing, and the problem is dealt with more seriously.<ref name="watson2017" /> | ||
In 1963 Penn from Johannesburg, after performing a proximal circular incision and pulling forward the penile skin to form a new prepuce, covered the denuded shaft with a "free graft", not indicating from where he took this graft.<ref name="penn1963" /> | In 1963 Penn from Johannesburg, after performing a proximal circular incision and pulling forward the penile [[skin]] to form a new prepuce, covered the denuded shaft with a "free graft", not indicating from where he took this graft.<ref name="penn1963" /> | ||
Goodwin covered the same defect in 1990 by implantation of the penis into the scrotum first and then liberating it in a second stage.<ref>{{REFjournal | Goodwin covered the same defect in 1990 by implantation of the penis into the scrotum first and then liberating it in a second stage.<ref>{{REFjournal | ||
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}}</ref> A pedicled island scrotal flap was used for the same purpose by Lynch and Pryor in a one-stage procedure in 1993. | }}</ref> A pedicled island scrotal flap was used for the same purpose by Lynch and Pryor in a one-stage procedure in 1993. | ||
One of the simplest methods involved the implantation of a small platinum ring within the tip of the "foreskin." The ring held the skin in place over the glans, resulting in a "created phimosis" (meaning that the skin could not be retracted while the ring was in place). The hope was to generate enough new skin to permanently re-cover the glans after the ring was removed. As it turned out the skin that was left was a fibrous, raised band where the platinum ring had been lodged and there was not enough skin to cover the glans.<ref name="bigelow1994">{{REFjournal | One of the simplest methods involved the implantation of a small platinum ring within the tip of the "foreskin." The ring held the [[skin]] in place over the glans, resulting in a "created phimosis" (meaning that the [[skin]] could not be retracted while the ring was in place). The hope was to generate enough new [[skin]] to permanently re-cover the glans after the ring was removed. As it turned out the [[skin]] that was left was a fibrous, raised band where the platinum ring had been lodged and there was not enough [[skin]] to cover the glans.<ref name="bigelow1994">{{REFjournal | ||
|last=Bigelow | |last=Bigelow | ||
|first=Jim | |first=Jim | ||
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==The jump to non-surgical methods == | ==The jump to non-surgical methods == | ||
While reviewing the results of the implanted-ring procedure, an engineer living in the Pacific Northwest hit upon the idea of using tape to hold the skin in place over the glans. His intent was to avoid both the surgery needed to have the platinum ring implanted and the unsightly fibrous band it left. This simple idea was circulated among a small network of men who had been sharing whatever information they could find on foreskin restoration as well as their ideas and experimentation. As a result, in 1982, [[BUFF]] (Brothers United for Future Foreskins) was born.<ref name="bigelow1994" /> | While reviewing the results of the implanted-ring procedure, an engineer living in the Pacific Northwest hit upon the idea of using tape to hold the [[skin]] in place over the glans. His intent was to avoid both the surgery needed to have the platinum ring implanted and the unsightly fibrous band it left. This simple idea was circulated among a small network of men who had been sharing whatever information they could find on foreskin restoration as well as their ideas and experimentation. As a result, in 1982, [[BUFF]] (Brothers United for Future Foreskins) was born.<ref name="bigelow1994" /> | ||
Despite the possible complications of surgery and the inevitable presence of scars, the main disadvantage seems to be the different color and texture of the original penile skin and the graft. This outcome may not be what the patient had expected; therefore, most foreskin restoration seekers nowadays prefer [[Tissue expansion| skin expansion]] systems, which avoid these problems. | Despite the possible complications of surgery and the inevitable presence of scars, the main disadvantage seems to be the different color and texture of the original penile [[skin]] and the graft. This outcome may not be what the patient had expected; therefore, most foreskin restoration seekers nowadays prefer [[Tissue expansion|skin expansion]] systems, which avoid these problems. | ||
Surgical foreskin restoration is only rarely, if ever, practiced today. | Surgical foreskin restoration is only rarely, if ever, practiced today. | ||
{{SEEALSO}} | {{SEEALSO}} | ||
* [[Basics of foreskin restoration]] | * [[Basics of foreskin restoration]] | ||
* [[Foreskin restoration]] | * [[Foreskin restoration]] | ||