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Zipper injuries frequently occur to the foreskin, the skin of the penis, and the scrotum. Zipper injuries result in entrapment of tissue when the zipper is opened or closed. It primarily occurs in uncircumcised young boys, intoxicated adults, the mentally handicapped, males not wearing underwear, and elderly men suffering from movement or cognitive disorders. The most common type of zipper entrapment compresses the skin between the sliding piece and the teeth of the zipper. Another type of entrapment involves the skin between the teeth of the zipper after the sliding piece has moved beyond the area.1,2 Multiple methods to extract the entrapped skin have been reported.1–11 These methods range from manipulation to tooth-by-tooth extraction to circumcision. Treatment should be guided by the type of entrapment.1 Removal of the zipper can be performed quickly using simple tools to extract the entrapped tissue and thus prevent secondary injury.

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The zipper is a simple device that is used daily by millions of people (Figure 131-1). It consists of a sliding piece that moves in two directions. The sliding piece is composed of a front and back plate connected by the median bar.5 The median bar is usually located at the top of the sliding piece. A finger grip is attached to the front plate of the sliding piece and functions as a handle to move the sliding piece. The teeth are two opposing sets of rectangular metal or plastic pieces attached to fabric to keep them aligned. Moving the sliding piece across an open zipper will interlock the teeth and close the zipper. Reversing the sliding piece direction will unlock the teeth and open the zipper.

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Although any skin can become entrapped in a zipper, it primarily occurs to the foreskin, penis, and scrotum. Entrapment often occurs in those who are in a rush to get dressed, not wearing underwear, intoxicated, or in a rush to zip up their pants. Zipper injuries are extremely painful. Patients are often unable to relieve the entrapment themselves and present to the Emergency Department for relief. Because this is an embarrassing injury, patients often present after several attempts at self-extraction and a few hours after the injury. The self-extraction attempts and delay to presentation often result in significant edema that can complicate the removal of the entrapped skin.

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Skin entrapped between the sliding piece and teeth or between the teeth of the zipper must be extricated. The skin should be extricated as soon as possible to minimize edema and prevent necrosis.

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There are no absolute contraindications to the removal of a zipper, the slider, or the teeth from an entrapped piece of skin. A Urologist should be consulted after releasing the entrapment in cases of significant edema, skin necrosis, urethral involvement, or ...

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