Turkish Journal of Plastic Surgery

: 2020  |  Volume : 28  |  Issue : 4  |  Page : 237--239

Hair-Thread tourniquet syndrome: Two case reports

Mustafa Sutcu, Gokce Yildiran, Osman Akdag 
 Department of Plastic, Reconstructive and Aesthetic Surgery, Selcuk University Medical Faculty, Konya, Turkey

Correspondence Address:
Dr. Gokce Yildiran
Department of Plastic, Reconstructive and Aesthetic Surgery, Division of Hand Surgery, Selcuk University Medical Faculty, Konya


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.

How to cite this article:
Sutcu M, Yildiran G, Akdag O. Hair-Thread tourniquet syndrome: Two case reports.Turk J Plast Surg 2020;28:237-239

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 2022 Sep 26 ];28:237-239
Available from: http://www.turkjplastsurg.org/text.asp?2020/28/4/237/296471

Full Text


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

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}

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}{Figure 3}


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


Conflicts of interest

There are no conflicts of interest.


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