Risk factors for zipper entrapment:
(1) uncircumcised
(2) redundant penile skin
(3) tight clothing
(4) lack of underwear, or displacement to side
Risk factors for complications:
(1) extensive and irregular skin lacerations
(2) delay in presentation for treatment
(3) contamination
(4) repetitive trauma following attempts to release the trapped skin
Resolution:
(1) traction after application of mineral oil
(2) cutting the median bar at the top of the zipper between the inside and outside faceplates (wire or bone cutter, dental saw, mini-hacksaw)
(3) circumcision
Risk factors making removal difficult:
(1) anxiety and hypermobility by the patient, which may require sedation or analgesia (local or general)
(2) edema
(3) problems accessing median bar
