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Necrotic Penile Lesion: What a Culture Swab Will Not Reveal

McGregor, Alyson J. MD; Ruskis, Jennifer MD

doi: 10.1097/01.EEM.0000408456.30525.83
Case Report


A42-year-old man presents complaining of a painful penile lesion. There are no associated fevers, rashes, or recent illness. He denies penile discharge, dysuria, and hematuria. He is sexually active with one female partner. He has no history of sexually transmitted infections. The patient revealed that five days prior to presentation, the dorsum of the penile body (shaft) skin became entrapped in his pants zipper. He spent three hours attempting to disengage the zipper by forcibly removing the skin from the zipper teeth. A closer examination of the wound reveals granulation tissue along the periphery with a center of dried blood that was easily removed with local wound care.

Zipper entrapment injuries of the penis, while uncommon, pose a unique problem to the patient and the practitioner on the best method to remove the zipper and salvage penile skin tissue. These injuries are most commonly seen in prepubertal boys, and can cause bruising, abrasions, localized swelling, and less frequently necrosis. Skin loss, as seen in the photograph, is also rare for these types of injuries if managed appropriately.

Treatment of zipper entrapment includes local anesthesia and prompt removal of the teeth. Prevention of a prolonged entrapment is critical to minimizing edema, which can lead to a more challenging procedure. Topical anesthetic creams or local infiltration of lidocaine can provide effective anesthesia with penile blocks reserved for severe injuries.

Removal techniques depend in part on the component of the zipper involved. Cutting the cloth around the zipper will open the teeth and allow removal of the skin. Mineral oil combined with gentle traction or a wire cutter may be necessary if the fastener is involved. Local wound care with topical antibiotic ointment is the recommended treatment for post-procedure care. Prompt urologic consultation is necessary if any injuries involve the urethra or if significant tissue loss is present.

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Dr. McGregoris an assistant professor of emergency medicine at the Warren Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital.Dr. Ruskisis an emergency medicine resident at Warren Alpert.

© 2011 Lippincott Williams & Wilkins, Inc.