Unnecessary full-thickness skin grafting for routine circumcision: when ignorance is far from bliss.

the corona. The traditional circumciser (mohel) was summoned to examine the infant, but despite efforts to achieve pressure dressing tamponade was unsuccessful at completely controlling the bleeding and he escorted the mother and infant to the nearest medical center. examination upon admission revealed ongoing oozing; the plastic surgeon therefore proceeded and took the baby into the operating room for thorough wound exploration and suturing as needed. Under general anesthesia the bleeding source was immediately identified and sutured. The surgical report stated that the neonate sustained a degloving injury and the urgent procedure was successful. That same day the media rushed to announce in repeated newscasts that a negligent circumciser flawed, resulting in dangerous bleeding in a helpless neonate. The following morning the head of the plastic surgery department explained to the parents that the harm caused to the baby's penis was negligently severe. He stressed that the critical damage to the genitalia warrants immediate surgical correction to prevent future interference to the child's quality of life and potential suffering from complications arising from the faulty procedure. According to the hospital report there was a urologi-cal consultation which was not available for review. The parents were persuaded to concede to have the plastic surgery team perform a full-thickness graft of skin donated from the baby's groin area. Convinced that the team was acting in the best interests of their child, the parents agreed and the procedure was performed. As the child's family physician and a volunteer traditional circumciser I grew for editorials see page 37 and 39 w hile it seems in the modern era of information explosion that everyone gains knowledge of everything, this apparently is a fallacy. Knowledge is far easily accessible, but its application needs experience and full training. How disturbing it is to learn of instances where good clini-cians grow oblivious of their limitations and mishaps occur attributable to hubris. This case report presents an instance where good intentions and perfect dex-terous proficiency cannot compensate for lack of basic knowledge imperative for delivery of satisfactory medical care. Patient descriPtiOn An 8 day old newborn underwent routine circumcision in the community. The procedure was performed as routinely customary in Israel, by the guillotine method, using a scalpel or sharp knife, excising the prepuce over a slit guard to prevent damage to the glans penis. A bandage ribbon was applied for hemostasis and the procedure proceeded uneventfully. An hour …