Penile zipper injuries are common among school-going boys and teenagers. It often occurs because the child is quickly trying to zip up their pants while being distracted by something else. It is more frequent among boys with uncircumcised penises as their foreskin gets entrapped in the zipper. It is uncommon in adults but can be noticed in adults with neurological disabilities.
Penile zipper injury can be a reason for pediatric emergency department visits. Suppose a child develops this injury at school or at home. In that case, it is best to consult a healthcare worker such as a nurse or doctor to release the affected tissues as gently as possible without causing any further damage. Boys may also feel embarrassed to receive treatment for this condition, so it is best to reassure them as much as possible. Consult a male healthcare worker if possible to feel more comfortable during the management of this injury.
The most common complaint with penile zipper injuries is pain. Since the skin of the penis is a very sensitive region, entrapment of these tissues in a zipper can cause a mild to severe amount of pain. Young children may present with uncontrollable crying or discomfort.
There may be signs of swelling and redness around the affected region. Entrapment of penile tissues may restrict the blood flow towards that region resulting in mild to moderate swelling. Bleeding is rare, but it may be noticed after the zipper releases the entrapped skin.
If the tissues are trapped in a zipper for a very long time, it may cause tissue necrosis in the affected region due to decreased blood supply. It can also result in scarring or bruising of the affected area. Therefore it is necessary to get treatment for it as soon as possible.
Before beginning with treatment, it is crucial to figure out whether anesthesia will be required or not. If a child is anxious and in extreme pain, sedation may become necessary by inhaling nitrous oxide. For mild injuries, applying a topical anesthetic agent is often sufficient. Injection of a local anesthetic agent is avoided unless necessary.
If there is swelling present, it is necessary to reduce it for easy removal. This can be done by compressing the affected region using a narrow elastic wrap. It should be applied for 10 to 20 minutes till swelling is reduced. Afterward, a mineral lubricant should be applied to facilitate the release of entrapped tissues.
The treatment procedure depends upon the location of penile tissue entrapment in a zipper. A zipper has two main components; a mobile head and interlocking teeth. If the skin of the penis is caught in the mobile zipper head, manual attempts should be made to bring down the zipper gently. If it is difficult to move the zipper head, use wire-cutting instruments to cut the medial part of the zipper head. This will detach it from the skin, releasing the affected tissues. If penile tissues are entrapped between the interlocking teeth, a horizontal cut is made on the material of the zipper below the point of entrapment. This will allow you to pull the interlocked teeth apart and free the affected region.
If manual measures are ineffective, you may need to take your child to the emergency department, recommended surgical intervention. A penile block is given to achieve local anesthesia followed by excision of the affected tissues. If this measure is unsuccessful, circumcision is done as a last resort.
Once the injury has been relieved, it heals well in the majority of cases. The healing period may vary from a few days to weeks, depending on the severity of the injury. Further care and attention should be provided to the affected child to prevent complications.
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Sabaa Alvi MD
Ayesha Aslam Mughal MD
