(See also Genital Trauma Genital Trauma Most genital trauma occurs in men and may involve injury to the testes, scrotum, and penis. Severe genital injuries occur most commonly on the battlefield, usually from ground explosives. Genital... read more .)
Entrapment of foreskin, penile skin, or scrotal skin within a zipper
Complications may include
Damage to skin
Edema, due to delay of treatment, may make the procedure more difficult and increase risk of tissue damage and necrosis.
Damage to the penis should be evaluated by a urologist, especially if clinical findings suggest urethral injury Urethral Trauma Urethral injuries usually occur in men. Most major urethral injuries are due to blunt trauma. Penetrating urethral trauma is less common, occurring mainly as a result of gunshot wounds, or,... read more .
Antiseptic cleanser (eg, povidone iodine)
Heavy-duty wire cutter or bone cutter
Sturdy shears, to cut through trouser material and across the zipper
Small (eg, Iris) scissors, to cut the zipper cloth between specific zipper teeth, if necessary, to remove them individually
Topical anesthetic cream or local anesthetic without epinephrine (eg, 1 or 2% lidocaine and a 25- or 27-gauge needle and about a 3-mL syringe)
This condition is painful, and patients also may be frightened and embarrassed. Calm reassurance is usually adequate to allow the procedure to be done. Occasionally mild sedation may be helpful.
Position the patient supine. To facilitate positioning, first use a bandage scissors, if necessary, to cut through the trousers peripherally around the zipper, which will relieve painful traction forces on the site and permit trouser removal.
Step-by-Step Description of Procedure
Inject local anesthetic into the area using a 25- or 27-gauge needle, or apply anesthetic cream.
Cut the median bar at the wide end of the zipper slider, which connects its front and back plates, using a sturdy wire cutter (diagonal cutter), or bone cutter. (See figure Zipper removal from penile skin Zipper removal from penile skin .) The slider will fall off in 2 pieces, allowing the zipper to be removed.
Alternatively, if no cutters are available, lubricate the zipper and tissue at the affected area, using mineral oil liberally.
Wait 10 minutes to allow the mineral oil to spread over the surfaces of the sliding mechanism, zipper teeth, and skin.
Make one gentle attempt to unzip the zipper. If this strategy either is deemed not likely to be successful or is unsuccessful, proceed to the next step. Do not damage the entrapped tissue by trying repeatedly to unzip the zipper.
As another alternative, if no cutters are available, try to separate the zipper teeth by cutting the cloth between them using a small (eg, Iris) scissors.
Zipper removal from penile skin
If these measures fail or are not feasible:
Obtain urologic consultation for possible elliptical skin excision or emergency circumcision.
Control bleeding with gentle local pressure.
Clean the site with warm water and soap.
Apply antibiotic ointment (eg, bacitracin) and wrap loosely in sterile gauze.
Warnings and Common Errors
Stop trying to unzip the zipper if one attempt is unsuccessful.
Tips and Tricks
Obtain and store appropriate sturdy cutters in a convenient location in advance as they may not be readily available otherwise.
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