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Hair-thread tourniquet syndrome
D J Barton1, G M Sloan, L S Nichter
1Division of Plastic Surgery, University of Southern California School of Medicine, Los Angeles, CA 90027.
Insights
Hair-thread tourniquet syndrome affects infants, causing appendage strangulation. Prompt fiber removal and conservative care lead to successful healing without significant tissue loss.
Area of Science:
- Pediatric Surgery
- Dermatology
Background:
- Hair-thread tourniquet syndrome is a condition where hair or fibers constrict an appendage in infants.
- It can affect toes, fingers, and external genitalia, presenting a risk of tissue damage.
Observation:
- Six infant cases (12 days to 5 months) presented with appendage strangulation.
- Offending fibers included hair (toe injuries) and synthetic fibers from mittens (finger injuries).
- Literature review identified 60 similar cases, with varying causes and affected sites.
Findings:
- Immediate removal of constricting fibers resulted in complete healing without significant tissue loss in all six cases.
- The middle finger and third toe are most susceptible to strangulation.
- Finger and penile involvement carried a higher risk of complications compared to toe involvement.
Implications:
- Prompt diagnosis and immediate removal of the offending fiber are crucial for successful treatment.
- Prolonged conservative management of distal tissue aids in maximal tissue salvage.
- Increased physician awareness is essential for prevention, diagnosis, and early intervention.
Abstract:
We have witnessed six cases of the hair-thread tourniquet syndrome, an entity characterized by strangulation of an appendage (toes, fingers, or external genitalia) by hair or hair-like fibers in the pediatric population. All six of our cases were in infants, 12 days to 5 months of age. The offending fibers were hair in three of the four patients with toe injuries and synthetic fibers from mittens in the finger cases. All six patients were treated by immediate removal of the constricting fibers, and, in spite of the worrisome appearance of the tissue distal to the constriction, all six eventually healed without significant tissue loss. A review of the literature indicated 60 similar cases of this type reported, 24 involving toes, 14 involving fingers, and 22 involving genitals. The majority of the toe and external genitalia cases were caused by hair, whereas the majority of finger strangulations were caused by thread from mittens. At greatest risk for strangulation are the middle finger and third toe, followed by the index finger and second toe. Patients with finger or penile involvement were more likely to suffer significant complications from the injuries than those patients with toe involvement. Based on our own experience and that described in the literature, we recommend prompt removal of the offending fiber, followed by prolonged conservative management of the damaged distal tissue, in the hope of maximal tissue salvage. Increased physician awareness of this syndrome is mandatory for prevention, diagnosis, and early treatment.