How is a detached frenulum repaired?

Surgical Repair of a Detached Frenulum

The detached frenulum should be repaired using interrupted 4-0 absorbable sutures while preserving the frenular artery to ensure optimal functional outcomes and prevent meatal stenosis. 1

Surgical Techniques for Frenulum Repair

Primary Suture Repair

• The most common approach for a detached frenulum is direct repair using interrupted 4-0 absorbable sutures to reapproximate the torn edges 1
• The frenulum should be divided cleanly with a scalpel rather than diathermy to minimize tissue damage 1
• The frenular artery must be preserved during repair to prevent complications such as meatal stenosis 2

Post-Procedure Care

• After repair, apply paraffin gauze with antibiotic paste followed by a light compression dressing for one day to maximize cosmetic results 1
• Personal hygiene should be maintained without additional local antiseptics or antibiotics in most cases 3

Alternative Techniques for Complex Cases

"Pull and Burn" Method

• For cases where the frenulum has partially detached or requires lengthening, the "pull and burn" method can be used 3
• This suture-free technique involves making a controlled vertical tear at the point of maximum tension using diathermy 3
• The procedure respects the anatomy of the glans penis and preserves the frenular artery 2
• This method has shown excellent functional and cosmetic results with no reported cases of meatal stenosis in long-term follow-up 2

Plastic Surgical Techniques

• For more complex repairs or cases with scarring, plastic surgical techniques such as V-Y plasty or Z-plasty may be employed 4
• These techniques have demonstrated high patient satisfaction rates (8.9/10) and good cosmetic outcomes 4
• Only 8% of patients required subsequent intervention after these procedures 4

Grafting Techniques

• In severe cases with extensive tissue loss or scarring, skin grafting may be necessary 5
• This involves excision of scarred tissue and insertion of a skin graft to the area 5
• Studies have shown 100% graft viability with good functional outcomes 5

Potential Complications and Prevention

• Injury to the frenular artery during repair must be avoided as it may lead to meatal stenosis 2
• Excessive use of diathermy can damage surrounding tissue and compromise healing 1
• Glans injury during repair must be prevented to ensure optimal functional outcomes 1
• Sutures that are too tight may cause pain or discomfort during healing 1

Follow-up Care

• Regular follow-up at 2-3 months postoperatively is recommended to assess healing and functional outcomes 2
• Patients should be evaluated for symptoms of meatal stenosis (dysuria and stream pattern abnormalities) 2
• Examination of the urethral meatus should confirm normal appearance with no signs of edema or scarring 2

The choice of repair technique should be based on the extent of the detachment, presence of scarring, and surgeon's expertise, with the primary goal being restoration of normal function while preserving the frenular artery to prevent complications.