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CASE REPORT |
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Year : 2017 | Volume
: 10
| Issue : 1 | Page : 79-81 |
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Hair tourniquet syndrome
Sandip Kumar Rahul1, Susama Behera1, Pallavi Suman2, Satyabir Mohapatra3
1 Department of Surgery, Nehru Satabdi Central Hospital, Talcher, Odisha, India 2 Department of Pediatrics, Central Hospital, Barajamda, Jharkhand, India 3 Department of Pediatrics, Nehru Satabdi Central Hospital, Talcher, Odisha, India
Date of Web Publication | 9-Jan-2017 |
Correspondence Address: Dr. Sandip Kumar Rahul S/O Shri Kapil Kumar Jha, Sector 6B, QR. No 2086, Bokaro Steel City, Bokaro - 827 006, Jharkhand India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.197919
Hair tourniquet syndrome presents as a surgical emergency. Early recognition and urgent intervention are needed for salvaging the involved digit. We present a case of an infant with this syndrome and discuss the important points in its management. Keywords: Hair tourniquet syndrome, ischemia, urgent intervention
How to cite this article: Rahul SK, Behera S, Suman P, Mohapatra S. Hair tourniquet syndrome. Med J DY Patil Univ 2017;10:79-81 |
Introduction | | |
Hair tourniquet syndrome (HTS) is a rare condition which obstructs the blood flow to the involved appendage leading to its ischemic injury. We describe a case with this condition, emphasizing on the importance of prompt diagnosis and urgent intervention to prevent irreversible ischemia.
Case Report | | |
A 3-month-old male child presented with swelling and redness of the left thumb since 2 days. No other symptoms were present.
Local examination revealed swelling, redness, and tenderness of the left thumb with a constriction proximally [Figure 1]. Peripheral pulses in the involved limb were normal. Other digits were healthy. Systemic examination was normal.
Examination under loupe magnification showed a hair in the constricting ring which was removed immediately using forceps and scissors [Figure 2]. Over the next 48 h, swelling gradually lessened and the child became symptom-free [Figure 3]. | Figure 3: Constriction ring and swelling of the digit perished after removal of the hair tourniquet
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Discussion | | |
HTS involves circumferential winding of hair or thread from clothing around one or more appendage leading to its strangulation due to vascular compromise. Initially, the venous and lymphatic flow is affected resulting in edema but later the arterial flow also gets hampered causing necrosis, gangrene, or autoamputation.[1] It has been observed that hair shrink on drying thereby aggravating the constriction.[2]
HTS has been variously described in the literature as toe tourniquet syndrome or Hair-thread tourniquet syndrome.[3],[4] Its exact incidence is unknown, but it has been accepted that it is underreported in literature. First described by Quin HTS commonly affects infants.[3] However, a few cases have been described in adults with impaired cognitive function.[5]
Hair or threads from clothing are the common culprits. After childbirth, mothers are in telogen effluvium phase and shed their hair which increases the risk to develop HTS.[6] Increased hair loss seen in chemotherapy patients also make the child vulnerable. When mittens and frequently washed old clothing is used, there is a chance for HTS to develop. It has sometimes also been described as a form of child abuse, and therefore, a careful clinical examination to rule out any other injuries is very important.
Most commonly involved parts are fingers, toes, and sometimes genitalia (penis and clitoris).[6] However, involvement of uvula and neck has also been reported.[7],[8]
Important differential diagnoses include ainhum and other causes of pseudoainhum.[9],[10]
Treatment consists of removing the constricting agent and if significant compartment syndrome is present, then a relaxing incision is needed to relieve it. If the hair or thread is easily visible during the examination, they can be cut using scissors or removed using forceps under magnification. Depilatory creams applied on intact skins have been found to weaken the hair fiber. However, most of the times, due to excessive edema, no definite constricting agent is visible, and this necessitates examination under anesthesia and complete release of the constricting ring to ensure unimpeded blood flow.
In our patient, the hair could be seen in the constricted region. It was easily removed and did not need any incision to relieve the compartment pressure.
To conclude, prompt diagnosis and urgent intervention in HTS save the digit from ischemic damage. Adequate parental counseling and effective preventive measures such as regularly checking the mittens and clothing for free hair/threads, and the child for any features of HTS helps in decreasing the incidence and morbidity of HTS.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
1. | Mackey S, Hettiaratchy S, Dickinson J. Hair-tourniquet syndrome – Multiple toes and bilaterality. Eur J Emerg Med 2005;12:191-2. |
2. | Summers JL, Guira AC. Hair strangulation of the external genitalia: Report of two cases. Ohio State Med J 1973;69:672-3. |
3. | Quinn NJ Jr. Toe tourniquet syndrome. Pediatrics 1971;48:145-6. |
4. | Harris EJ. Acute digital ischemia in infants: The hair-thread tourniquet syndrome – A report of two cases. J Foot Ankle Surg 2002;41:112-6. |
5. | Miller RR, Baker WE, Brandeis GH. Hair-thread tourniquet syndrome in a cognitively impaired nursing home resident. Adv Skin Wound Care 2004;17:351-2. |
6. | Strahlman RS. Toe tourniquet syndrome in association with maternal hair loss. Pediatrics 2003;111:685-7. |
7. | Chegwidden HJ, Poirier MP. Near strangulation as a result of hair tourniquet syndrome. Clin Pediatr (Phila) 2005;44:359-61. |
8. | Krishna S, Paul RI. Hair tourniquet of the uvula. J Emerg Med 2003;24:325-6. |
9. | Kumar P, Gandhi V. Pseudoainhum in psoriasis. Indian J Dermatol 2012;57:238-9. [ PUBMED] |
10. | Klusmann A, Lenard HG. Tourniquet syndrome – Accident or abuse? Eur J Pediatr 2004;163:495-8. |
[Figure 1], [Figure 2], [Figure 3]
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