CIRCLIST - Ismail Clamp

This clamp works on the same principle as the Tara KLamp but has a screw thread locking device rather than a single-use latch. Prototypes (as illustrated above) were sterilised by Gamma Irradiation but this discoloured the plastic, so the Malaysian manufacturer has switched to using the Ethylene Oxide method.

Early criticisms of the design centred on the possibility of an unwilling or meddlesome boy unscrewing the device before the healing process was complete, potentially precipitating a disaster. To date no such occurrences have been reported although in theory the danger seems to remain. Another disadvantage of this design is that the process of removal of the clamp does not inevitably destroy it, leading to the possibility of unscrupulous re-use with consequent risks of infection.

One positive benefit of the screw thread closure is that a degree of partial clamping can be accurately set whilst the foreskin is adjusted. This is particularly important if a tight circumcision has been specified; in that event not only foreskin but also shaft skin must be drawn through the clamping ring.

The ability to set an accurate partial grip at this stage of the process, as appropriate to the thickness of the individual patient’s skin, greatly facilitates control of the positioning of the clamp and makes the Ismail Clamp particularly well suited to very tight circumcisions. Note, though, that like most similar clamps, the clamping ring is perpendicular to the axis of the clamp and not angled to match the natural slant of the coronal rim of the glans. Thus there is a tendency for this clamp to remove relatively too little skin dorsally. This must be counteracted by the surgeon.

In common with other fit-and-wear clamps, the Ismail Clamp does not naturally remove the frenulum. To achieve a fully ‘low’ circumcision with this device it appears to be necessary first to detach the frenulum from the glans, otherwise the clamp will not be properly seated in the ventral position.

Manufacturer’s website: http://www.ismailclamp.com/

Finally, it should be noted the clamp is designed to be used by a skilled physician or other trained healthcare provider. Despite its apparent simplicity, this is not a ‘do it yourself’ device.

1. The black line indicates the desired position of the clamp, which is then attached so as to cover this mark. In this instance, a dorsal slit has been made to ease the insertion of the clamp beneath the foreskin.

2. Ventrally, the proximal face of the clamp is close to the point where the shaft skin joins the scrotum.

3. Dorsally, the back of the clamp is in close approximation to the abdomen. Note the quantity of tissue held between the surgeon’s left thumb and forefinger. A large proportion of the shaft skin is being removed along with the whole of the inner and outer foreskin, so as to achieve a low and (by Malaysian standards) exceptionally tight circumcision.

4. Note the commendably narrow band of necrotic tissue produced by this clamp and the excellent final result it achieves.

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Images © 2006, CIRCLIST Editorial Staff. Click thumbnail to enlarge.



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