What is the name of the artery located at the 6 o'clock position during a circumcision?

The Frenular Artery in Circumcision

During circumcision, the frenular artery is located at the 6 o'clock position of the penis, at the junction of the frenulum with the ventral aspect of the glans. 1

Anatomical Significance

The frenular artery is a critical anatomical structure during circumcision procedures due to several important factors:

• It provides blood supply to the frenulum and ventral aspect of the glans
• It runs within the frenulum at the ventral midline (6 o'clock position)
• Injury to this artery can lead to significant bleeding during the procedure
• Preservation of this artery may reduce postoperative pain and complications

Surgical Implications

Different circumcision techniques handle the frenular artery differently:

Sleeve Technique

• Preserves the frenular artery at the 6 o'clock position
• Associated with less bleeding and reduced need for electrocautery
• Results in less postoperative pain and fewer complications
• Provides better hemostasis and prevents partial ischemia 1

Dorsal Slit Technique

• Often cannot preserve the frenulum at the 6 o'clock position
• Requires traction on skin and mucosa that may injure the frenular artery
• Associated with higher risk of bleeding from the frenular artery
• May lead to increased postoperative pain due to frenular artery injury 1

Clinical Outcomes

Research has demonstrated that preservation of the frenular artery during circumcision has several benefits:

• Reduced postoperative pain scores
• Lower incidence of emergence agitation
• Decreased need for additional analgesia
• Fewer complications such as bleeding and ischemia 1

A study comparing the sleeve technique (which preserves the frenular artery) with the dorsal slit technique found that patients who underwent the sleeve technique required significantly less analgesia postoperatively, with 76.6% requiring no additional analgesia compared to only 40% in the dorsal slit group 1.

Complications of Frenular Artery Injury

Damage to the frenular artery during circumcision can lead to several complications:

• Significant bleeding requiring additional hemostatic measures
• Increased pain during the early postoperative period
• Potential for meatal stenosis due to ischemia and scarring
• Possible urethral fistula formation in severe cases 2, 3

The "pull-and-burn" method for frenulum correction has been shown to respect the delicate vasculature of the frenular area, preserving the integrity of the urethral meatus and preventing meatal stenosis 3.

Best Practice Recommendations

When performing circumcision:

1. Identify the frenular artery at the 6 o'clock position before making any incisions
2. Consider using techniques that preserve the frenulum and its arterial supply when appropriate
3. If the frenular artery must be divided, ensure meticulous hemostasis using precise electrocautery or suture ligation
4. Be prepared to manage bleeding from the frenular artery, which may be more significant than from other areas of the circumcision

By understanding the location and importance of the frenular artery at the 6 o'clock position, surgeons can minimize complications and improve outcomes in circumcision procedures.