A 2 month old previously healthy male infant is brought to the emergency department after his parents notice a circumferential wound around the fifth toe with some distal swelling and hyperemia. The mother states she saw a hair wrapped around the digit.
Why it matters:
Hair tourniquet syndrome is due to constriction of a finger, toe, or genitalia by hair or cloth fibers which can lead to tissue injury and necrosis if left untreated. The mechanism often involves stretched, wet hair being wrapped around the digit. As the hair dries, it loses its elasticity and causes constriction. Hair tourniquet syndrome is an important differential consideration in the inconsolable infant.
Treatment involves removal of the constricting band mechanically (via a forceps, scissors, or in difficult cases a scalpel) and/or chemically (using a commercially available depilatory cream such as Nair). Good lighting and magnification (eg, otoscope) will be important as the hair may be difficult to visualize. Chemical removal has become more common and can be used as a primary technique, but it is important to note that it will not
be effective on cloth or synthetic fibers. The agent is liberally applied to the area for 10-30 minutes, washed off, and then followed by removal of the hair remnants with forceps. Chemical removal can be repeated if necessary, and is also advantageous when the hair is deeply embedded within the skin and cannot be mechanically removed.
It is important to reassess the patient after release of the tourniquet to ensure that there is improvement in the swelling. If there is no improvement or some uncertainty that the circumferential constriction has been relieved, further consultation and potentially operative intervention may be necessary.
References:
1. Abbasi AA. Chapter 122. Hair Tourniquet Management. In Reichman EF. Reichman’s Emergency Medicine Procedures 3rd Edition. McGraw-Hill. 2019.
2. Dunphy L, Verma Y, Morhij R, Lamyman M. Hair thread tourniquet syndrome in a male infant: a rare surgical emergency. BMJ Case Reports. 2017 Nov 1.
3. Liow RY, Budny P, and Regan PJ. Hair thread tourniquet syndrome. J of Accid Emerg Med. 1996 Mar;13(2):138-9.
Written by Dr. Scott Sherman, Cook County Health, Assistant Program Director