A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn’t require resource-intensive procedural sedation, and is quick.
The 4 most common types of zippers are nylon coil zip, plastic mold zip, metal zip, and invisible zip. Most of the techniques describing solutions on zipper entrapment in the medical literature are derived from case reports and case series. All revolve around understanding zipper anatomy and obtaining adequate exposure to assess how the skin is entrapped. The penile skin often is entrapped either in the sliding mechanism (also known as the endplate) or between the teeth of the zipper.
Figure 1. Anatomy of a zipper
Penile Entrapment Injury Management Techniques in Literature
Reported techniques for releasing zippers include [1, 2]:
- Cut the sliding mechanism (aka the endplate) using metal cutters.
- Use a flat screwdriver placed underneath the sliding mechanism and rotate it.
- Use mineral oil for lubrication.
- Use lateral compression technique to relieve the tension on the trapped skin.
- Cut the zipper and pull the teeth apart.
All these techniques are associated with variable rates of success. Some of these techniques such as using metal cutters might lead to iatrogenic injuries.
The problem is that the child’s penile skin is entrapped within a metal zipper, where many recommended methods for zipper entrapment removal won’t work.
Trick of the Trade: Removing Metal Zippers
- Lidocaine gel
- Blade or scissors
- The zipper should be separated from the pants as much as possible to minimize painful stretching or pulling of the penile skin.
- Apply lidocaine gel on the area of entrapment for 2-3 minutes.
- Identify the exposed teeth closest to slider and cut off the zipper at that level (blue dots) while avoiding penile skin (Figure 2).
- Gently advance the zipper body forward, pulling either the tab or the body itself, to disengage it from the teeth. You may need to add more lidocaine gel or other lubrication to facilitate this sliding motion.
- The remaining parts of the zipper can easily be disengaged from the skin (Figure 3).
Figure 2. Cutting off the zipper between the teeth (blue dots) and advancing the zipper body (yellow arrow)
Figure 3. Freed zipper body
Interested in Other Tricks of the Trade?