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CASE REPORT
Year : 2020  |  Volume : 28  |  Issue : 4  |  Page : 237-239

Hair-Thread tourniquet syndrome: Two case reports


Department of Plastic, Reconstructive and Aesthetic Surgery, Selcuk University Medical Faculty, Konya, Turkey

Date of Submission08-Jul-2019
Date of Acceptance17-Oct-2019
Date of Web Publication28-Sep-2020

Correspondence Address:
Dr. Gokce Yildiran
Department of Plastic, Reconstructive and Aesthetic Surgery, Division of Hand Surgery, Selcuk University Medical Faculty, Konya
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_62_19

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  Abstract 


Hair-thread tourniquet syndrome is wrapping of hair or similar material that straps around and strangulates the limbs such as fingers or toes. This syndrome is a pediatric emergency and is a serious condition that can cause limb necrosis. In this report, we aimed to present two cases of hair-thread tourniquet syndrome. Case 1 was an 8-week-old female infant who had edema and ecchymosis on the third finger. Edema and ecchymosis regressed after the removal of hair. Case 2 was a 2-week-old baby boy who had developed a strangulation in the deep plan of the second and third fingers. After 2 days of hair removal, edema and ecchymosis regressed. Hair-thread tourniquet syndrome is a pediatric emergency and may cause finger or toe necrosis. Its treatment is simple and it is a differential diagnosis that should be kept in mind in strangulated organs.

Keywords: Finger, hair thread, syndrome, toe, tourniquet


How to cite this article:
Sutcu M, Yildiran G, Akdag O. Hair-Thread tourniquet syndrome: Two case reports. Turk J Plast Surg 2020;28:237-9

How to cite this URL:
Sutcu M, Yildiran G, Akdag O. Hair-Thread tourniquet syndrome: Two case reports. Turk J Plast Surg [serial online] 2020 [cited 2020 Oct 29];28:237-9. Available from: http://www.turkjplastsurg.org/text.asp?2020/28/4/237/296471




  Introduction Top


Hair-thread tourniquet syndrome is a condition where a hair or hair-like rope wraps a limb and causes ischemia in the limb.[1] Hair-thread tourniquet syndrome was first published in 1832 in Lancet.[2] The syndrome is a rare condition and has severe results unless treated. It usually affects infants and children due to accidental or child abuse.[2] This condition can be seen in body parts such as the toe, finger, penis, labia minor, around a hemangioma, and hypertrophic clitoris.[1],[2],[3],[4] The hair around the limb works as a tourniquet and causes ischemia. This syndrome is very important due to the risk of losing the limbs through tissue necrosis. Hair-thread tourniquet syndrome, which is an emergency situation, may be unnoticeable if it is not examined carefully and it may be considered as an infection or it may be confused with amniotic band syndrome in newborns.[1] In these cases, treatment is delayed and results in loss of the limb. In this study, we aimed to present two cases of hair-thread tourniquet syndrome.


  case Reports Top


Case 1

An 8-week-old girl was referred to our clinic with irritability and swelling of her right third toe. On physical examination, there was marked edema and ecchymosis to the distal interphalangeal (DIP) joint of the third toe [Figure 1]. A hair loop was found just distal to the DIP joint, wrapped several times around the third toe. There were no signs of tissue necrosis. The hair fiber was cut out and removed under local anesthesia and loupe magnification. The wounds were treated with topical antibiotic ointment, and the edema resolved and the toe returned to normal. Neither wound nor vascular problems were observed on follow-up.
Figure 1: Hair-thread tourniquet syndrome in an 8-week-old girl, strangulated third toe, edema, and color changes

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Case 2

A 2-week-old boy was referred with a 2-day history of irritability, swollen, and venous congestion of the left second and third toes. On examination, he had a deep, circumferential groove over the middle phalanx of the second toe with the distal part of the toe severely swollen and marked distal venous congestion [Figure 2]. A hair loop was found wrapped several times around the second and third toes. The strangulation was fully released, and the knotted hair loop was removed. Congestion subsided over the next few days [Figure 3]. The toes healed well with conservative wound care.
Figure 2: Two-week-old boy, strangulated both second and third toes, severe ecchymosis and ischemia in the distal portion of the second toe, and edema in the third toe

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Figure 3: Two days after the release of the toes, edema and ecchymosis were diminished

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  Conclusion Top


Hair-thread tourniquet syndrome, in which a hair or hair-like material has a tourniquet effect on the limb, was named by Barton et al. in 1988.[5] In this syndrome, the arterial circulation is impaired and necrosis occurs after the lymphatic and venous circulation had impaired due to the tourniquet effect of the hair.[1],[6] Hair can coil to the fingers, toes, and penis more easily so that these limbs are affected more commonly. In the literature, penis, toes, and fingers are the most affected organs, respectively.[7],[8]

It often affects children under 1.5 years of age.[3],[7] It has been reported that the age range of the cases affecting the external genitalia is 4–14.[4] The cases in this report were 2-week-old and 8-week-old infants, and these ages were compatible with the literature.

The baby's fingers can be wrapped around the hair in the socks or in the mitten, and this is considered as the main etiology, as well as the poor hygiene, child abuse, and cultural situations.[4],[7] Mitten or socks should be changed daily, and if the hairs inside are cleaned, hair-thread tourniquet syndrome is avoided. However, these babies are often neglected babies. In some cultures, it is believed that hair wrapping on the fingers of newborns removes the evil spirits.[7] Hair-thread tourniquet syndrome in infants in this study is thought to be since the hairs entering into the sock by chance are not changed for days.

In the literature, cellulitis, erysipelas, trauma, or skin irritations such as insect bites have been reported in the differential diagnosis of hair-thread tourniquet syndrome.[3] However, since this syndrome is observed mostly in young children and is a rare condition, it may also be confused with amniotic band syndrome if no detailed history is taken.[9]

Physical examination findings are a proximally strangulated finger or toe and circulatory problems at the distal and color changes, and these are quite similar to those in amniotic band syndrome. It is inevitable that this condition will be misdiagnosed as amniotic band syndrome, especially in newborns, and this will result in the necrosis of the finger or toe unless the correct and detailed history was taken from the parents. Hair-thread tourniquet syndrome is expected to exist for a short time, whereas amniotic band syndrome is a congenital deformity. The cases in this report were 2-week and 8-week-old infants. Therefore, it was inevitable to consider amniotic band syndrome in the differential diagnosis. However, it was concluded that they were no congenital cases in their detailed history taken from the families.

The diagnosis of hair-thread tourniquet syndrome can be made with a very careful physical examination and detailed anamnesis. The treatment of this emergency situation is quite simple: cutting the hair or hair-like material and save the limb from ischemia is the main treatment for hair-thread tourniquet syndrome. After the diagnosis was made by careful examination in two cases, the hair was cut out and the toes were freed from ischemia. However, if the hair cannot be cut off, surgical removal of this strangulation is described in the literature.[7] In this condition, strangulation can be removed with a simple longitudinal incision deep to the bone.[10]

In conclusion, hair-thread tourniquet syndrome, which is a pediatric emergency, may be difficult to diagnose for a physician, but its treatment is simple, and this is a differential diagnosis that should be kept in mind in strangulated organs and distal limb ischemia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Baştuǧ O, Korkmaz L, Korkut S, Halis H, Kurtoǧlu S. Hair-thread tourniquet syndrome in a preterm baby. Turk Pediatri Ars 2015;50:245-7.  Back to cited text no. 1
    
2.
Okur OM, Coskun A, Kayipmaz AE, Ozbay S, Kavalci C, Kocalar UG. Hair-thread tourniquet syndrome originating from a haemangioma in an adult patient. J Pak Med Assoc 2016;66:896-7.  Back to cited text no. 2
    
3.
Kuiper JW, de Korte N. Hair thread tourniquet syndrome in a toe of an 18 mo old girl. World J Clin Cases 2015;3:368-70.  Back to cited text no. 3
    
4.
Parlak M, Karakaya AE. Hair-thread tourniquet syndrome of the hypertrophic clitoris in a 6-year-old girl. Pediatr Emerg Care 2015;31:363-4.  Back to cited text no. 4
    
5.
Barton DJ, Sloan GM, Nichter LS, Reinisch JF. Hair-thread tourniquet syndrome. Pediatrics 1988;82:925-8.  Back to cited text no. 5
    
6.
Alvarez-Pérez A, Mateo S, Fernández-Redondo V, Toribio J. Hair-thread tourniquet syndrome: A hidden hazard. Pediatr Dermatol 2013;30:e61-2.  Back to cited text no. 6
    
7.
Mat Saad AZ, Purcell EM, McCann JJ. Hair-thread tourniquet syndrome in an infant with bony erosion: A case report, literature review, and meta-analysis. Ann Plast Surg 2006;57:447-52.  Back to cited text no. 7
    
8.
Sivathasan N, Vijayarajan L. Hair-thread tourniquet syndrome: A case report and literature review. Case Rep Med 2012;2012:171368.  Back to cited text no. 8
    
9.
Hill RH, James ES. Digital strangulation by hair wrapping. Can Med Assoc J 1967;97:1293.  Back to cited text no. 9
    
10.
Mackey S, Hettiaratchy S, Dickinson J. Hair-tourniquet syndrome – Multiple toes and bilaterality. Eur J Emerg Med 2005;12:191-2.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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