Cosmetic results of circumcision and scar wrinkling: Do we exaggerate in terms of hemostasis and sutures?

Objective: To objective of this study was to investigate poor scar appearance of the circumcision line and scar wrinkling caused by the sutures placed during the circumcision in primary school age circumcised children. Methods: A total of 455 children aged between 6 and 9years, circumcised by four different specialists in our hospital between 2009 and 2018 were evaluated. Circumcisions performed due to balanitis, phimosis, secondary phimosis, and paraphimosis were excluded from the study. Only routine religious circumcisions performed on request of the family were included in the study. Children underwent a second procedure and those receiving treatment after the circumcision due to infection were excluded from the study. About 363 patients included the study. Patients were evaluated according to the Fitzpatrick skin type classification, independent observer scale, Stony Brook Scar Evaluation Scale, and Dunn-Bonferroni test. Results: No statistically significant difference was found between distributions of scar wrinkling levels in children according to the circumcision (p>0.05). There was a statistically significant difference between age of circumcision according to scare wrinkling levels (p=0.001). According to the Dunn-Bonferroni test; the circumcision age was found to be significantly lower in children with severe scar wrinkling compared to the children with no or mild scar wrinkling (p=0.001; p=0.011). Conclusion: The tense, short-interval sutures placed away from the wound margin during circumcision in order to control subcutaneous bleeding lead to scar wrinkling and a poor cosmetic appearance. Knowing the risk factors leading to scar wrinkling and taking appropriate measures will provide acceptable cosmetic outcomes after the circumcision.