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Try to determine the site of bleeding:
General oozing from the glans penis. This usually minor and can be controlled with direct pressure with a sterile gauze, if necessary.
Bleeding from or around the frenulum (see Figure 1 anatomy photo below). Note where the frenulum starts: At or below the corona, not on the glans penis. Any frenulum-like structure on the glans is an “adhesion” and needs to be carefully lysed. Note: In many uncircumcised men, once you retract the foreskin, you will find a narrow band of scar tissue or fibrous band starting from just below the meatus on the glans and that incorporates the inferior frenulum.
In this image: Figure 1. This photo shows bleeding from or around the frenulum.
Prevention of parafrenular bleeding:
Avoid trauma to the frenulum during lysis of “adhesions”.
Avoid using too large of a Gomco bell that may stretch or tear the frenulum.
Avoid excess removal of prepuce ventrally (refer to subsection Poor Cosmetic Result in this section)
Prevention of bleeding from the circumcision wound site:
Inspect for a defective clamp before starting. Lack of a minimum clearance of 2 mm from the rocker arm and the base plate is the most common defect. Refer to the section about Normal and Defective Clamps.
The nut is not snuggly tighten. This seems to rarely be a problem, unless the Gomco clamp wasn’t properly in place initially when the nut was tightened and later the rocker arm slips into place and the nut is subsequently too loose. A loose nut on the rocker arm won’t provide sufficient squeezing tightness at the bell-bevel hole interface, leading to poor hemostasis at the wound site.
Wait five minutes before loosening of the nut and removal of the Gomco clamp.
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