A painful and anxiety-provoking complaint which can occur in the process of zipping or unzipping trousers
It is most commonly seen in pre-school and early school age boys
There has often been a pre-hospital attempt to free the entrapped tissues, which may have been distressing
As this is a relatively rare form of trauma, it is worth seeking the assistance of a colleague in the department who has had experience with a similar injury to enable help with management
It is important to be sensitive, especially with adolescents
It may be preferable to have male medical/nursing staff involved if possible
There are two patterns of entrapment seen and the genital tissue may be:
Entrapped in the mobile zipper head
Caught between the interlocking teeth of the zipper
Keep the child in their most comfortable position (e.g. parents lap or supine on the bed)
An explanation of the procedure along with reassurance and a gentle approach will help to gain a compliant patient
Sedation and Pain management
Analgesia is vitally important and should be given early
Inhaled nitrous oxide may be useful with aiding the removal procedure
Conscious sedation may be necessary to the distressed and anxious child
EMLA® topical anaesthetic applied for a period of time to numb the affected area.
Dorsal Penile Block
Some centres have advocated local infiltrate of lignocaine (never use adrenaline with this) but this is usually only required for significant skin or tissue entrapment (usually unnecessary)
Mineral oil (lubricant) applied to the affected area for 10 minutes may assist to free the penile tissue when gentle traction is applied.
It may be necessary to cut closely around the zipper so the rest of the trousers/jeans are no longer in the way. This must take place if the zip is to be cut through without causing any unnecessary traction on the exquisitely painful tissues.
1. Entrapped in the mobile zipper head:
Use wire cutters to cut through the median bar of the zipper fastener
The front and back plates will then fall apart and allow the skin to be freed
2. Caught between the interlocking teeth of the zipper
If the skin is caught below the zip as shown in the diagram below– cut across the zip at point 2 (inferior to the entrapment site) to enable the two interlocking rows of the teeth to be gently pulled apart freeing the skin
If the zip is still entangled in the skin it will be necessary to pull the zip up forcefully to create the situation in 1
Ensure there has been no significant damage to the penile meatus
Other small lacerations or bruises usually heal very well
Significant injuries to the tissues should have surgical review
Routine nursing care.
Bothner J (2014) Management of zipper injuries. UpToDate. Accessed at www.uptodate.com
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