包皮再手術時用於縫合的鉻腸線應否拆除?
許耕榕
栩仕診所男性功能重建中心、臺大醫學院泌尿部
Should chromic suture be removed in revised circumcision?
Geng-Long Hsu,
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology and Department of Urology, National Taiwan University, Taipei, Taiwan
Purpose:
To study whether skin track can be prevented by removal of chromic sutures after circumcision in males.
Materials and Methods:
A prospective study was conducted between January 2012 and November 2015. A total of 168 males underwent sleeve method, with 5-0 chromic suture, to revise their circumcisions. The data collected include number of skin track, track orientation, track distribution, and cause of the circumcision revision. They were allocated into natural (n=87), natural absorption of chromic suture, or suture removal (n=81) group, stitch removal one week postoperatively respectively. No electrocautery was used during the entire procedure. Follow up was made 1 and 6 months postoperatively and data were collected for comparisons.
Results:
All the skin tracks are perpendicular to the circumcision line, i.e. along the suture track. Skin track was unexceptionally noted in all patients preoperatively and in the natural group postoperatively while it was uncommon in the removal group. There was no difference in skin track number (5.3±1.5 vs. 5.3±1.5; p=0.90) between groups preoperatively, however, significant differences were seen postoperatively at one month (2.9±1.3 vs. 0.5±0.1; p<0.01) or 6 months (3.3±1.4 vs. 0.6±0.1 p<0.01). No difference in skin track was seen during follow up or anatomical location (57.0% vs. 53.4%; p=0.08). Histology showed that lining of the skin track was constituted of stratified squamous epithelium which is exactly the same as the foreskin. This implies that epithelialization encourages the formation of the skin track and hence accumulates the sebum plug.
Conclusion:
Chromic suture material seems appropriative to be removed after one week in adult circumcision.