Excessive Removal of Prepuce
In this image: Figure 1. This photo shows the correct placement of dorsal clamp.
Alternative Goal
Leave about 4-5mm of foreskin left from the tip of the dorsal clamp. See Figure 1 above.
Avoid stretching the prepuce and penile skin over the glans while placing the dorsal clamp. See Figure 2 below with excessive stretching of the prepuce over the glans.
Figure 2. This photo shows excessive stretching of the prepuce over the glans.
See photo Figure 3 below for an another example of an extended, but not overly stretched prepuce, and proper placement of the dorsal clamp.
In this image: Figure 3. This shows an another example of an extended, but not overly stretched prepuce.
Choose a proper bell size. A too large bell size for the penis will lead to excessive foreskin removal and risks partial denudation of the penile shaft skin. Note: The bell does not have to completely cover the glans to be a proper and effective size.
Avoid pulling the penile shaft skin over the bell-covered glans.
Avoid pushing the bell down onto the glans. The glans and entire penis are flaccid structures and can relatively easily pushed into the pre-pubic fat.
The ultimate goal of the circumcision is to have the relaxed preputial remnant just covering the corona. See Figure 4 below.
In this image: Figure 4. The ultimate goal of the circumcision is to have the relaxed preputial remnant just covering the corona.
Below is an unfortunate example in a three-year-old boy of excessive removal of foreskin down to the mid-penile shaft with hypopigmented scar formation between the excised penile shaft skin and the corona. No stretching of the penile skin is being done.
