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Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
An area of skin, often of the penis or neck, becomes painfully trapped in a zipper mechanism. Unzipping the zipper will lacerate the skin and cause further damage.
This condition is relatively rarely seen, but is the most common cause of prepuce injuries in children. In one study, only 6 boys were seen over a period of 3 years.In another, there was only one case of zip entrapment in 4,068 new patient attendances.
Various options can be tried, some more invasive than others. It is usually necessary to dismantle the zip. If the skin trapped is minor and recent, dismantling the zip from below will sometimes work. If this is not successful then a technique to release the pressure between the zip plates will free the trapped skin. The options include the following:
- It may be possible to dismantle the zip. If the median bar at the front of the moveable zip head is cut in half, the zipper falls apart freeing the skin relatively painlessly. Use bone cutter or wire clippers for this. Considerable force may be needed.
- Lateral compression of the zip, using pliers, sometimes frees the prepuce.
- Cutting the teeth of the closed zipper is sometimes effective.
- The thin blade of a small screwdriver can be inserted between the outer and inner faceplates of the zip fastener and a twisting movement made toward the median bar. This will widen the gap between faceplates and may help to disengage the prepuce.
- If all else fails, the skin should be anaesthetised and the area of zipper and entrapped tissue should be excised. Mineral oil is sometimes used in these circumstances to lubricate the area and minimise trauma.
- Consider plastic surgical follow-up if the skin damage is significant.
Further reading and references
Yip A, Ng SK, Wong WC, et al; Injury to the prepuce. Br J Urol. 1989 May63(5):535-8.
Wyatt JP, Scobie WG; The management of penile zip entrapment in children. Injury. 1994 Jan25(1):59-60.
Mishra SC; Safe and painless manipulation of penile zipper entrapment. Indian Pediatr. 2006 Mar43(3):252-4.
Inoue N, Crook SC, Yamamoto LG; Comparing 2 methods of emergent zipper release. Am J Emerg Med. 2005 Jul23(4):480-2.
Raveenthiran V; Releasing of zipper-entrapped foreskin: a novel nonsurgical technique. Pediatr Emerg Care. 2007 Jul23(7):463-4.
Mydlo JH; Treatment of a delayed zipper injury. Urol Int. 200064(1):45-6.