Toe tourniquet syndrome caused by cable tie

Tourniquet syndrome clinically presents as pain, discoloration, paresthesias, and swelling distal to a constricting band. If left untreated or unrecognized, it may induce ischemia, resulting in tissue necrosis or auto amputation of the appendage. Treatment involves removal of all constricting bands and monitoring of the neurovascular status of the digit after constriction removal.

A healthy 7-year-old female had tied a cable tie around her toe for an unknown amount of time before evaluation. After examination of the toe and concern for ischemia, the cable tie was removed. Once the cable tie was removed, the area of necrotic tissue at the dorsal proximal phalanx was gently debrided taking special care to avoid the extensor tendon, which was exposed but appeared to be intact. Tetanus prophylaxis was updated, she was sent home on oral antibiotics and she went home with dressing changes. The patient was referred for a psychiatric consultation due to the unique nature of the self-injury and concern for possible underlying disorder.

This case is the first in the literature to describe toe tourniquet syndrome caused by a cable tie. This case highlights the importance of treatment of the offending structure with release and to monitor the digit for signs of ischemia. A thorough history should be sought from both the patient and, in this case, the patient's caregiver to seek any additional clues of depression, anxiety, or anger. If warranted, appropriate consultation of a psychiatrist may be warranted.