In order to maintain the phimotic prepuce intact postoperatively, many authors have suggested their personal techniques. These except for the already mentioned [2
] are reported as variations of Z-plasty [7
], multiple Y-V plasties [8
], lateral prepuceplasty [9
], multiple internal foreskin lamina [10
] and triple incision plasty [11
]. The surgeon should select patients with a real problem of phimotic prepuce and not pseudophimosis, which may be solved with topical apposition corticoid cream [12
There are few in vivo studies evaluating the tissue reaction to suture materials that mainly depend on how the suture polymer interacts with the tissues. Synthetic polyesters, which we usually use in phimosis surgery, degrade with hydrolysis and cause minimal tissue reaction, although they have been associated, in some cases, with recurrences.
On the other side, the healing process is better in growth especially in younger patients. With SLP we interfere with the healing process and differentiate the healing mechanism in wound epithelium formation that we leave the wound to heal "of its own accord", but with daily foreskin retractions. So, finally the widening of the foreskin is permanent.
Sutureless prepuceplasty also possesses significant advantages. It is a faster, bloodless and with lower cost operation (avoiding suturing and shortening the hospitalization), the foreskin retraction is painless, the prepuce is left loose and without tension, there are no suture materials which may induce reactions, there are no postoperative scars or recurrences, the prepuce, postoperatively, looks more natural, the initial results are better and the parents seem to prefer this technique. When phimosis coexists with excessive prepuce, postoperative appearance after prepuceplasty maintains the same. So, the parents have to decide for an operation that may preserve the foreskin intact or not.
The main differences between sutured and sutureless prepuceplasty are the following: After dorsal relieving incision of the phimotic foreskin, it retracts loosely without tension. The stitching of the wound causes a minor or middle grade of difficulty for the same movements. The way of healing is different, without sutures in the second procedure SLP it's "a moving tissue healing". Initially the healing in SLP by second intention is retarded, because it is under anti-inflammatory action of topical steroids cream for 10 days, in order to maintain the prepuce loose and prevent the postoperative adhesions' formation. This is followed by a faster stage of directed healing, using cicatrizing creams topically.
Finally, the last difference refers to the way of increasing the narrowing prepuce surface. In SLP, we let the wound close in a functional way, leading to the desiring result. In other words the wound is left to heal of its own accord.
The final postoperative aesthetic and functional result is remarkable. Dorsal elongated incisions of prepuce in paraphimoses and in hypospadiac surgery had a good healing by second invention. Automatic disruption of the prepuce in a case of nephrotic syndrome with elongated wounds also had excellent further alike healing. The absence of post-traumatic ingenerated cicatrix tissue is due to the rich prepuce blood vessels, in the absence of sutures and in usefulness of cicatrizing creams.