11.13 Zipper Caught on Penis or Chin
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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
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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:
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- 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
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img/cse1113.gif

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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