Zipper injuries: Extrication technique

Zip injuries are the second most common cause of genital injuries in children. Several management techniques are reported. However these techniques are difficult and potentially dangerous, requiring general anaesthesia. “Rolling back” technique is an easy and safe method of extrication, without any mechanical device or anaesthesia. Objectives: To categorise zip injuries, to elucidate the principle behind the “Rolling back” technique, to educate the  clinicians on how to extricate zip injuries and to prevent zip injuries by educating their parents. Method: Simulative experiments were conducted by entrapping cloth in the zip and extrication by “Rolling back” technique. Children in the age group 1 to 18 years with zip injuries presenting to the outpatient department (OPD) or emergency room (ER) were studied for 3 years. “Rolling back” technique has two components. If the skin is entrapped while closing the zip, then extrication is to open the zip. If entrapment occurs while opening the zip, then the technique is to close the zip. Results: Of 35 cases, 34 (97.2%) were boys and one (2.8%) was a girl. Twenty eight (82.4%) boys were uncircumcised and 06 (17.6%) were circumcised. Twenty five (71.4%) had anterior entrapment and 10 (28.6%) had posterior entrapment. In both types, uncircumcised boys had higher risk of entrapment. All were successfully managed by the “Rolling back” technique. Conclusions: Of 35 zip injuries seen in this study 71% had anterior entrapment and 29% had posterior entrapment. All zip injuries were successfully managed by the “Rolling back” technique. Sri Lanka Journal of Child Health, 2018; 47 (2): 149-154