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Tue, 9 Apr 1996 23:49:15 -0700 |
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> Dear Jay (Janet?),
>
> You wrote:
>
> > Subject: Re: Frenotomy
> > I have a client who is having a heck of a time finding someone to do a
> > frenotomy and "Is sedation necessary"
>
> Have you considered contacting some Family Practice docs. I know I'm a
> little biased, but I find that overall they have a more holistic approach
> than most peds. I worked with a great group for 6 years and the "oldest
> doc" (about 45'ish?) was the one who pointed out to me that frenotomies
> used to be so common that the circumcision instruments till have a little
> cutting notch on the other end which was used for frenulum clipping.
>
> "Can someone give me a detailed description of frenotomy?"
>
> He showed me how to do my first one and I've done one more since then. We
> didn't sedate either one. (It can't possibly hurt 1/1000th as much as
> circ.! and most are not sedating them although most of "my" docs do penile
> block nowadays.) With the first child I just had mom hold baby's body
> /arms (she was a nurse--not worried about being too upset by this
> procedure) and my nurse hold the head steady. When the baby opened wide to
> cry I used sterile surgical scissor and gloves to snip the thick, white
> extra-frenula tissue. The tongue moved with the cry but the frenulum
> actually seemed surprisingly "still." So it wasn't as difficult as I had
> imagined. I did 2 or 3 tiny snips (1mm each?) til I saw a drop of blood
> (or less?) and knew I was done. I don't recall the baby crying any harder
> when I hit blood. We immediately handed baby to Mom to nurse and she was
> ecstatic as there was IMMEDIATE relief for her. This was her 3rd nursed
> baby and she had come to us saying "something isn't right; it hurts and I'm
> sore." She just kept repeating her happy surprise at the change. Before
> she left, I checked the sleeping baby's mouth--no blood or evidence of the
> "surgery."
>
> My 2nd one was not as easy as we were in the hosp--decided to try using the
> "circ.board"--papoosing device--which the kid absolutely hated. Did same
> procedure but don't recall any blood (plenty of sweat on me though--don't
> like tied down, screaming, trying to thrash babies--goes against my
> instincts!!) but knew I had cut thru plenty of non-vascularized tissue
> (again just a few mm). This Mom had not noticed any soreness as we had
> been unabe to get him to latch much prior. He still didn't latch
> immediately but did well within a couple of weeks. His Mom's a BF peer
> counselor now.
>
> Meg Wright, PA-C
> Physician Assistant
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