11.13 Zipper Caught on Penis or Chin

agk’s Library of Common Simple Emergencies

Presentation

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 only 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.

Illustration

-----------------------------------------------------
from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES ©
Longwood Information LLC 4822 Quebec St NW Washington DC 20016-3229
1.202.237.0971 fax 1.202.244.8393 electra@clark.net
-----------------------------------------------------