Foreskin reconstruction, purse string versus wedge resection
April 4, 2010
Good morning Dante,
The purse string suture technique has a lot of appeal in that wedge resection and incision healing is not involved. I would favor using a permanent suture which would be removed about 6 to 8 weeks later. Some reactive scarring and contracture should occur as a result and this may achieve the effect you are seeking. If the distal circle now is very large circumferentially, then wedge resection would be appropriate.
If the purse string suture approach is not effective, we can always revert to wedge resection.
Your call, but I will make recommendations when I see you.
Remember surgery would be inappropriate if the new foreskin does not completely drape a good 1/4″ to 3/8″ over the head of the flaccid glans.
If there is continued interest, please initiate a consultation by sending us a fee of 250 which is a one time charge, includes E-mail chatting, telephone calls, and your first visit to the office, excluding lab tests.
Have a restful weekend,.
Harold M. Reed, M.D.
305-865-2000
At 06:25 PM 4/2/2010, you wrote:
Hello Dr. Reed, I can’t tell you how impressed I am that you are dialoging with me about this. This is so atypical to most physicians I have dealt with. I guess as this point I would like to know your professional opinion upon what is the best procedure; the purse-string suture or cutting out a wedge and suturing the foreskin? I must admit that removing any part of what I have worked to hard to obtain seems anathema, but I also know that you have much more experience in these things than I. I also want to make sure (if it is realistic) that I don’t end up with what would be the equivalent of a phimosis. This procedure is not only for me but for the sake of my partner as well. He is uncut, so I’m familiar with how things are ‘supposed’ to work. I’m also aware that I should not have unrealistic expectations. If we go with the string, will I need to abstain from any kind erection for those 4 weeks? Is that the same for any other procedure? There is no problem with that, I only need to know what I should expect. The second question I have is about timing. Should I go ahead with some sort of procedure, when is your schedule open to do it, and what is the recovery time? I live in Dallas so I will need to make a special plan to go to Miami. I have friends in Miami, Key West, Orlando and Tampa, so accommodation should not a problem. But I have a job and will need to request time off well in advance. Thank you again for working with me on this. I have waiting a long time (over 3 years) to get to this point. I’m so grateful to have a Dr. that is not freaked out my such questions and requests. Dante________________________________________ From: Harold M. Reed, M.D. [ Subject: Re: Finishing touch of foreskin restoration April 2, 2010 Good morning Dante, The first article mentions very briefly purse string suture, but does not disclose, whether it is permanent left in or removed later on, or absolvable. The second article written by Dr. Greer, who I conferred with about 15 years ago, uses a technique similar to ours, also described by Dr. Willard Goodwin. So, we can do the purse string if you wish. My recommendation is to leave the suture in for a good 4 weeks if tolerated and some scarring will result around the suture and then, remove it. While I am familiar with the application of a purse string I have not had any experience for the reason you mention. Sincerely, Harold M. Reed, M.D. At 11:23 PM 3/31/2010, you wrote: >http://www.cirp.org/library/restoration/greer1/