Anatomy of the Zipper Fastener

Management → attempt should be made to remove fastener as quickly as possible as time and edema make success more difficult

1. Consent - bleeding, scarring, infection, failure of removal, poor cosmetic, other morbidity; hematoma, bruising, vasospasm from dorsal penile block

2. Anesthesia

a. Local → LMX (wait 30 minutes) or EMLA

b. Dorsal penile block → lidocaine and/or bupivacine WITHOUT epinephrine injected at the junction of the base of penis and suprapubic skin at 2 and 10 o’clock; a pop is usually felt as you get to Buck’s Fascia, ~3-5 mm

3. Antiseptic solution

4. Technique → primarily based on observational studies and case reports/ series

a. Entrapment of skin between zipper teeth without fastener involvement

i. Cut the cloth on dotted lines as indicated in figure then zipper teeth can easily be disengaged from skin

b. Entrapment of skin between zipper teeth with fastener involvement

i. Slide thin blade flat screwdriver between faceplates on side opposite of entrapped skin, rotating blade toward median fastener to widen the gap between faceplates; fastener should break open and pull teeth apart

ii. Apply mineral oil x 10-15 minutes and gentle traction to free tissue; dishwashing soap is another alternative

iii. Cut the median fastener with wire cutters → the textbook method but can be difficult per video linked below

1. Emergency Medicine News Penile Skin Release

iv. If entrapment persists despite these attempts, prompt urology consultation for local excision of entrapped skin or circumcision

5. Aftercare

a. Swelling, bruising, abrasions expected

b. Dysuria → apply triple antibiotic ointment while urinating

c. Return to ER or urology office for inability to void or hematuria

References

https://www.uptodate.com/contents/management-of-zipper-injuries?source=s...