Zipper injury is usually seen in young children. The foreskin becomes entrapped in the teeth of the zipper or between the fastener and the zipper teeth as the zipper is being opened (downward). Accessibility to the median bar of the zipper facilitates removal.
Penile Zipper Injury. Entrapment of the foreskin between the fastener and the zipper teeth is seen. The median bar is exposed and easily accessible for cutting. (Photo contributor: Kevin J. Knoop, MD, MS.)
Management and Disposition
Treatment is directed at removing the zipper and freeing the entrapped penile foreskin or prepuce while minimizing trauma and pain. A penile block with local injection at the base of the penis eases removal but might not be necessary if the child is cooperative and removal can be effected atraumatically. Several methods are described depending on the mechanism.
Penile Zipper Injury. Separation of the zipper by cutting the median bar of the zipper with a bone cutter allows release. (Photo contributor: Kevin J. Knoop, MD, MS.)
Penile Zipper Injury. Crushed tissue after zipper removal did not obstruct urine flow in this patient. (Photo contributor: Kevin J. Knoop, MD, MS.)
Zipper entrapment of the penis is one of the most common genital injuries in prepubertal boys.
When tissue is entrapped by the zipper teeth only, release can be effected by cutting the cloth of the zipper either between the teeth or below the point of entrapment.
Cutting the median bar with a bone cutter allows the whole zipper to fall apart and release the entrapped skin.
Lateral compression of the distal zipper fastener with pliers may immediately release the tissue without need for anesthesia. This method requires application of equal pressure to both the anterior and posterior fastener plates simultaneously.
After removal, ensure that the urethra is patent and the child can void.