Circumcision shortens the skin that is attached at the base of penis at one end, and at the coronna of
glans at the other. Normally, that skin is longer than that distance and thus
overflows over the glans.
In the case of a cosmetic circumcision, there is much freedom in how much and
where the skin is to be removed. In the case of a phimosis, the location of
the phimotic/tight skin dictates where the skin must be removed, and also
dictates a minimum amount of skin to ensure all the inelastic skin is removed.
Over the millenia, there have been many techniques developped to accomplish the
circumcision. But in the end it comes down to 5 major groups/principles. A
more graphic description is located at the bottom of this page.
Dorsal slit
The dorsal slit isn't a true circumcision as it does not cut all
around nor does it remove skin. It allows the diameter of a tight ring of
phimotic skin to be expanded at the cost of shortening the skin near the
incision. The phimotic skin is not removed. When the incision goes the full
length of the foreskin, the end result is a glans which fully exposed on the
dosral side, but with plenty of excess skin on the ventral side. At the other
end, with just a minimal incision, it just makes for a slightly longer foreskin
on the ventral side, a type of foreskin that is not uncommon in the normal
prepuce.
A dorsal slit is also often used during a circumcision in order to achieve
retraction of foreskin necessary during many types of circumcision.
Sleeve resection
With the skin retracted, two circular incisions are made along the shaft. The
skin between those 2 incisions is removed, and the two edges brought together.
This technique offers the widest variety of styles both on where the scar will
be located (from base of penis as is popular in Japan to the rim of the head as
is popular in France) and in the amount of skin removed.
Temporary crush
This is the technique used by the popular Gomco device. It is conducted over
the glans where the skin has 2 layers (skin coming from coronna and skin
coming from base). Skin destined to survive is temporarily crushed/squeezed
and the skin distal to it is then cut right next to the squeezed skin. Because
the skin has 2 layers where the incision is made, it actually cuts the skin in
2 locations. The Gomco device is then removed and sutures are then made to
keep the two edges together during healing. It is often said that the Gomco is
responsible for the darker band of skin near the scar as a result of the skin
having been crushed temporarily. This technique offers good flexibility in
resulting circumcision styles except that its range does not allow the scar to
be located so close to the rim of head nor very far down the shaft near its
base.
Necrosing crush
This technique is used by devices such as the Platibel, Tara Klamp, Zhenxi ring
as well as many others and is the easiest to accomplish and requires no
sutures. The skin is crushed for about 5 days. During this time, the skin
distal to the crush is deprived of its blood, dies and is easily removed
without any pain or blood. Because the crush is made by squeezing the 2
layers together, under the crushed zone, the 2 skin layers are also deprived of
blood, become extremely thin and bond together. When the ring is removed, the
crushed skin will fall off within a few days, leaving the two skin edges bonded
together without any sutures.
Cutting at the tip
This is a technique used by the Jewish during their Bris ceremony for newborn
babies. Some adult circumcisions using "guided forceps" technique also use this
principle. The skin is pulled beyond the tip of the glans, a small clamp used
to both reduce blood flow and provide a guide for the scalpel, and the tube of
skin distal to the clamp is cut. Once the clamp is released, the outer layer
of skin retracts, and the inner layer is then manually retracted, and the 2
edges sutured together. (Note that during Brish performed on infants, sutures
are not used, nor are they used for Gomco circ on infants).