Anesthesia
Topical agents, local infiltration of anesthetic, nerve blocks, and moderate sedation can be used singly or in combination.
The choice of technique may vary depending on the clinician’s skill, the appendage involved, the patient's age, and the patient's ability to cooperate.
Immobilization techniques may be required.
For more information on anesthetic administration techniques, see the following articles:
Equipment
The necessary equipment for removal of hair or thread tourniquet is dictated by the method chosen by the practitioner. Individual circumstances may require alternative or additional equipment.
Equipment for the unwrapping method is as follows:
-
Gloves
-
Pincer instrument, if necessary (eg, fine-tipped forceps, hemostat)
Equipment for the cutting method is as follows:
-
Gloves
-
Local or regional anesthesia materials
-
Scalpel blade, No. 11
-
Povidone-iodine (eg, Betadine) solution
-
Fine-tipped forceps
-
Ear wax curette
-
Fine-tipped hemostat
-
Blunt probe
-
Fine-tipped scissors
Equipment for the depilatory method is as follows:
-
Gloves
-
Commercial depilatory cream
-
Water source for subsequent removal of depilatory cream
Patient Preparation
Positioning varies based on the anatomic part involved. A position that maximizes exposure of the involved appendage or body part while providing sufficient lighting is recommended; care should also be taken to maximize patient comfort.
-
In this figure, the blade is in the 9-o'clock position. The dorsal alternative approach is also indicated.
-
The blunt probe method.
-
This illustration shows removal of a penile tourniquet using the blunt probe method.
-
This cross-section of the finger illustrates the 3- and 9-o'clock positions as well as the alternative dorsal approach for digital tourniquet removal.
-
To avoid the deep structures, the incision must be kept within the deep fascia of the penis. This figure illustrates the importance of the 4- and 8-o'clock positions. The dorsal neurovascular bundle is not compromised by these approaches.
