Usually a child has gotten dressed too quickly and not wearing underpants,
accidentally pulled up penile skin into his zipper. The skin becomes
entrapped and crushed between the teeth and the slide of the
zipper, thereby painfully attaching the article of clothing
to the body part involved (most often the penis or less often the area
beneath the chin).
What to do:
Paint the area with a small amount of povidone-iodine and
infiltrate the skin with 1% lidocaine (plain). This will
allow the comfortable manipulation of the zipper and the
article of clothing.
Cover the area with mineral oil. This lubricates the
moving parts and often frees the skin without having to cut
the zipper.
If the mineral oil alone does not work, then cut the zipper away from the article of clothing to leave
yourself with a less cumbersome problem.
Cut the slide of the zipper in half with a pair of metal
snips or an orthopedic pin cutter. The patient is less
likely to be frightened if this procedure is kept hidden
from his view. If you are unable to break the two halves of the zipper slide apart using a metal cutter, then take two heavy duty surgical towel clamps and place their tongs into the side grooves at both ends of the slide. then grip one clamp firmly in each hand and then twist your wrists in opposite directions. This often will pop the two halves of the zipper slide apart, releasing the entrapped skin.
Pull the exposed zipper teeth apart, cleanse the crushed
skin, and apply an ointment such as povidone-iodine.
Tetanus prophylaxis should be administered as needed.
What not to do:
Do not cut clothing if mineral oil releases the zipper.
Do not destroy the entire article of clothing by cutting
into it. You only need to cut the zipper away allowing
repair of the clothing.
Do not excise an area of skin or perform a circumcision; it
onlv creates unnecessary morbidity for the patient.
Discussion
Newer plastic zippers have made this problem less common
than in the past, but it still occurs, and it is a very
grateful patient who is released from this entrapment.
References:
Nolan JF, Stillwell TJ, Sands JP: Acute management of the
zipper-entrapped penis. J Emerg Med 1990;8:305-307.
Kanegaye JT, Schonfeld N: Penile zipper entrapment: a simple
and less threatening approach using mineral oil. Pediatric
Emergency Care 1993;9:90-91.
