Comparative analysis of five methods of emergency zipper release by experienced versus novice clinicians.

The entrapment of penile tissue (foreskin, shaft, or glans) within the actuator or teeth of a zipper accounts for one of the most common genital injuries in young boys [1]. Literature suggests that zipper injuries are relatively uncommon, and that localized edema and pain are the most common outcomes, with significant injury such as skin loss and necrosis occurring rarely [1,2]. The purpose of our studywas to compare five common techniques for releasing zipper-entrapped skin using an animal model. This was a prospective, randomized trial using an animal model consisting of chicken skin firmly entrapped by a metal zipper on a pair of denim jeans. Volunteers consisted of 12 Emergency Medicine (EM) physician faculty and 18 medical students (novice clinicians). During the simulation lab, participants were taught the five common techniques for releasing zipper-entrapped skin: 1) cutting the median bar, 2) using a screwdriver to separate faceplates, 3) manipulation of the zipper using mineral oil lubricant, 4) lateral compression of the zip fastener using pliers, and 5) removal of teeth of the zip mechanism using trauma scissors [2-6]. The order in which the techniques were performed by each volunteer was chosen by a random number generator. Subjects were timed by evaluators using a digital stopwatch from the time they began until the successful release of the entrapped skin, or for five minutes, whichever came first. Success was defined as the release of the entrapped skinwhileminimizing trauma to the skin. Failure to successfully release the skinwithin fiveminutes, or causing full thickness laceration to the skin, were logged as failures.