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Written by Doug Wallace
This animal model study compared the classic median bar technique for zipper skin entrapment release to a novel approach. There was no upside or downside to using the new technique.
Chicken skin apparently works well as a penile skin model
Zipper entrapment of skin, most commonly penile skin, is a time sensitive emergency that can result in serious complications if not treated. Classic treatment approaches include lubrication and manual release, removing zippers’ teeth with trauma shears, and cutting the median bar (Figure 1, red arrow) with wire cutters. This randomized cross-over study compared the classic median bar technique to a novel technique. The novel approach involves using wire cutters in an inferior approach (Figure 2) to target the space between the zipper plates. Once in place, squeezing the wire cutters should cause the zipper plates to separate and the zipper to fall off of the teeth. A picture is actually worth a thousand words in this case: see Figure 3 and 4 below, slightly modified from source article.
Clinician participants were randomized to perform both techniques in random order on zipper-entrapped raw chicken skin in a simulation setting. Time to release, iatrogenic tissue injury, and successful release were similar for both techniques. The authors acknowledge the limitations of the study design and recommend using whatever technique works best for you and your patients.
How will this change my practice?
With both techniques having similar efficacy, I may consider using the study’s novel approach the next time I encounter zipper-entrapped skin.
Source
Improvising on the Fly: Comparison of a Novel Technique for Emergent Zipper Release to a Well-Established Technique in a Simulated Setting. J Emerg Med. 2024 Oct;67(4):e351-e356. doi: 10.1016/j.jemermed.2024.05.001. Epub 2024 May 17. PMID: 39191623
