Hair tourniquet syndrome of the toe

NewsBot · Feb 19, 2010

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Hair tourniquet syndrome of the toe: report of 2 new cases.
García-Mata S, Hidalgo-Ovejero A.
J Pediatr Orthop. 2009 Dec;29(8):860-4.

This report describes 2 new cases of toe tourniquet syndrome without accompanying signs of irritability. They were an 18-month-old girl and a 5-month-old boy suffering from strangulation of the third toe. The period of evolution was 20 days and 5 weeks. The toe worsened, with more extensive reddening and swelling, and deepening of the circular groove. Since a hair tourniquet was suspected, attempts were made to grasp the fiber with small-sized, blunt, and hook-shaped instruments, and mosquito clamp, with no success. The strand of hair compressing the toe lay deeper than expected. As improvement was barely noticeable, 2 dorsal paratendinous incisions were made and the hairs were extracted. Our aim is to raise awareness in the pediatric orthopaedic community of the existence of this syndrome, with a view to promoting the earliest possible diagnosis and appropriate management. In case of impossibility of removing the hairs we propose performing 2 dorsal paratendinous incisions, deep to the bone, to release completely the strangulation.
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NewsBot · Apr 17, 2015

Hair thread tourniquet syndrome in a toe of an 18 mo old girl.
Kuiper JW, de Korte N.
World J Clin Cases. 2015 Apr 16;3(4):368-70. doi: 10.12998/wjcc.v3.i4.368.

Hair thread tourniquet syndrome is rare and usually affects little children. If the tourniquet is not incised, the affected body part becomes ischemic or even necrotic. An 18 mo old girl was seen in the emergency ward with a painful, red and swollen third toe of the left foot. The toe appeared to be strangulated with a hair, and the diagnosis hair thread tourniquet syndrome was made. After incision of the hair tourniquet the symptoms soon subsided. The diagnosis is easily made if the clinical features are recognized. However, if the tourniquet is not cut through, the affected body part may become ischemic and even necrotic.
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NewsBot · Dec 18, 2015

Toe-tourniquet syndrome: A rare potentially
devastating entity
Baloch N et al
Malaysian Orthopaedic Journal 2015 Vol 9 No 3

Toe-tourniquet syndrome is a rare and commonly
misdiagnosed condition caused by a hair or a fiber wrapped
around digits (fingers and toes). A four months baby girl who
was crying and presented with redness and swelling at her
2nd and 3rd toes of right foot. Child had red and swollen 2nd
and 3rd toes of right foot with hair end protruding through
wounds. Constricting hairs were cut and removed. Toetourniquet
syndrome is a rare entity which is caused by hair
wrapped around a toe or a digit. Diagnosis is mostly clinical.
In order to prevent this condition to happen, education of
parents and clinicians is a cornerstone.
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NewsBot · Jan 14, 2016

Hair-thread tourniquet syndrome in a preterm baby
Osman Baştuğ, Levent Korkmaz, Sabriye Korkut, H?lya Halis, Selim Kurtoğlu
Turk Pediatri Ars 2015; 50: 245-7

Hair-thread tourniquet syndrome is a rare disorder characterized by the encircling of an appendage by a hair or thread. It usually occurs in children under
the age of one year. The tourniquet syndrome may occur in different parts of the body, particularly in toes, fingers, penis, clitoris, labia, neck and uvula. It
is an emergency condition that induces progressive edema, ischaemia and tissue necrosis and can lead to autoamputation of digits or other strangulated
structures. Emergency treatment is careful removal of the constricting fiber. We report a preterm newborn with hair-thread tourniquet syndrome affecting
multiple toes born at the 28th gestational week with the aim of preventing potential complications by increasesing awareness of the condition.
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NewsBot · May 19, 2016

A single center retrospective review of hair tourniquet syndrome and a proposed treatment algorithm.
Bean JF, Hebal F, Hunter CJ.
J Pediatr Surg. 2015 Sep;50(9):1583-5

INTRODUCTION:
Hair tourniquet syndrome (HTS) is a rare disorder characterized by a hair becoming tightly wound around an appendage. There is little known about the epidemiology, optimal treatment, or indications for surgical intervention in HTS. We hypothesized that HTS could be readily diagnosed and treated in the pediatric emergency department and we sought out factors predictive of surgical intervention.
METHODS:
We performed a single center retrospective review of all patients who presented with a hair tourniquet from May 2004 till March 2014.
RESULTS:
Eighty-one patients were diagnosed with HTS, ranging in age from 2 weeks to 22 years. Of these patients, 69 were located on the toes, 5 on fingers, and 7 on genitalia. The average ages for each location were statistically different (p<0.0001). Ninety-four percent of patients were successfully treated by nonoperative means. Cellulitis was found in two patients. Tissue necrosis occurred in one patient.
CONCLUSION:
HTS is an uncommon disorder and location differs with age. Chemical depilatory agents should be a first line treatment for this condition in most patients. If chemical tourniquet release fails, then the patient should undergo mechanical tourniquet release. If edema, erythema and pain fail to resolve after tourniquet release, then persistent hair tourniquet should be investigated.
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Jose Antonio Teatino · Jun 2, 2016

Dear colleagues:
I just had a case of digital strangulation by a hair , but nearly cost him a finger to my adult elderly patient .
I never imagined that one could tie hair spontaneously , causing digital necrosis was avoided by chance , calling the unusual pain patient after removal of a callus .

NewsBot · Jun 14, 2016

Can washing socks without flipping inside out cause hair tourniquet syndrome? A claim with two case reports.
Uygur, Esat; ?ark?i, Engin; Unkar, Ethem
Journal of Pediatric Orthopaedics B., June 10,

Hair tourniquet syndrome (HTS) is a rare, painful condition that results when hair or pieces of thread become wrapped tightly around toes, fingers, or other appendages, occluding blood flow and causing strangulation or amputation. Although the aetiology of HTS is unclear, we postulate that washing baby socks in a washing machine without turning them inside out might be a cause. Mothers should be informed about HTS and this simple prevention method should be suggested to them. Here, we present two cases of HTS and discuss possible causes.
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NewsBot · Jan 28, 2017

Can washing socks without flipping inside out cause hair tourniquet syndrome? A claim with two case reports
Uygur, Esat; Çarkçi, Engin; Ünkar, Ethem
Journal of Pediatric Orthopaedics B: March 2017 - Volume 26 - Issue 2 - p 193–194

Hair tourniquet syndrome (HTS) is a rare, painful condition that results when hair or pieces of thread become wrapped tightly around toes, fingers, or other appendages, occluding blood flow and causing strangulation or amputation. Although the aetiology of HTS is unclear, we postulate that washing baby socks in a washing machine without turning them inside out might be a cause. Mothers should be informed about HTS and this simple prevention method should be suggested to them. Here, we present two cases of HTS and discuss possible causes.
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NewsBot · Feb 21, 2017

From Today.com:
Hair tourniquet: Dad warns others after twisted hair nearly took off baby's toe

NewsBot · Aug 18, 2017

Can washing socks without flipping inside out cause hair tourniquet syndrome? A claim with two case reports.
Uygur E, Çarkçi E, Ünkar E.
J Pediatr Orthop B. 2017 Mar;26(2):193-194

Hair tourniquet syndrome (HTS) is a rare, painful condition that results when hair or pieces of thread become wrapped tightly around toes, fingers, or other appendages, occluding blood flow and causing strangulation or amputation. Although the aetiology of HTS is unclear, we postulate that washing baby socks in a washing machine without turning them inside out might be a cause. Mothers should be informed about HTS and this simple prevention method should be suggested to them. Here, we present two cases of HTS and discuss possible causes.
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NewsBot · Aug 29, 2017

A Case of a Baby Care-Related Accident: Hair-Thread Tourniquet
Syndrome.
Uymur EY, Köse A, Topal M, Dinçer R, Güzel MF.
J Emerg Med Case Rep 2017; DOI: 10.5152/jemcr.2017.1898

Introduction: We present the case of a 3.5-month-old boy whose right second toe was affected by hair/thread wrapped around
it and this situation’s urgency.
Case Report: A 3.5-month-old boy was brought by his parents to the emergency clinic. The patient had a swollen, reddish-color
right second toe with hyperemia. The parents did not know for how long the toe was affected. When ananmese was deepened,
no disorder was learned observing at birth. No other disorder was observed by the parents until they visited the emergency
department at noon. No pathology was detected on plain radiographs. By continuing physical examination, a hair-wire wrapping
around the toe with linear skin lesion was explored. Lesion was over extensor tendon on the dorsal face and intracutaneous on
the plantar face. The wire was meticulously removed, and the dorsal skin lesion was sutured. Proper wound care was performed.
On the 10th day, the sutures were removed. No sequelae were observed on follow-up. Based on the attitude of the parents and the
cooperation of medical professionals, the case was considered to be a baby care-related accident.
Conclusion:
Hair-thread tourniquet syndrome of an affected limb part is a life-threatening condition. Because it is rarely observed, its diagnosis can be delayed. However, ischemia of the affected extremity should alert the physician. Whenever the syndrome is diagnosed, proper treatment must be immediately initiated.
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NewsBot · Nov 7, 2017

Hair thread tourniquet syndrome in a male infant: a rare surgical emergency.
Dunphy L et al
BMJ Case Rep. 2017 Nov 1;2017. pii: bcr-2017-221002. doi: 10.1136/bcr-2017-221002.

Hair thread tourniquet syndrome (HTTS) is a rare surgical emergency that occurs when one or more appendages are acutely circumferentially strangulated by human hair. If left untreated it may induce prolonged ischaemia, resulting in tissue necrosis or autoamputation of the affected digit. It may involve the fingers, toes, penis or labia. It typically occurs in infants, but cases have also been reported in adults. Prompt recognition and treatment by complete removal of the constricting agent is crucial to preserve the affected tissue. We report a case of HTTS affecting the left middle toe of an 8-week-old male infant successfully treated by surgical release of the hair. The authors aim to raise awareness of HTTS among physicians, emergency doctors, paediatricians and surgeons, as prompt recognition and management prevents adverse outcomes and tissue necrosis.
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NewsBot · Jan 23, 2018

Utility of ultrasonography in hair-thread tourniquet syndrome
Deshan F. Sebaratnam et al
Pediatric Dermatology 16 January 2018

A 2-year-old girl presented with a 2-month history of an erythematous, indurated plaque with well-defined borders on the third toe of the right foot. Bedside high-resolution ultrasonography demonstrated a thickened epidermis overlying a hyperechoic focus within the dermis. Her clinical and sonographic presentation was in keeping with a foreign body causing hair-thread tourniquet syndrome. The foreign body was surgically extirpated without neurovascular sequelae. Ultrasonography expedited accurate diagnosis and is a promising adjunct to clinical evaluation for radiolucent foreign bodies.
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NewsBot · May 24, 2018

Hair toe tourniquets: a review of two case studies.
Booth J, Morse T
Emerg Nurse. 2018 May 22. doi: 10.7748/en.2018.e1756.

Digit hair tourniquets are relatively uncommon. There are reports in the literature of hair tourniquets involving other appendages, such as the penis and uvula, however the phenomenon is not widely recognised and is often overlooked by healthcare professionals. This article discusses two case studies in which hair was responsible for creating a tourniquet around a digit. The article explores possible causes and management options for patients, with reference to the case studies. Midwives and health visitors are central to minimising the risk of injury to children as they can educate expectant mothers about this potential problem.
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NewsBot · Feb 28, 2019

Hair torniquet syndrome, an unusual presentation: A case
report and review of literature
Sadaf Mohammed Basheer et al
Int J Case Rep Images
2019;10:100992Z01BS2019.

Introduction: Hair tourniquet syndrome is rare
presentations that are not often encountered in
orthopedic OPD’s. The syndrome was recognized
long back but there have only been a few published
reports in regard to the sequel it follows. The
usual case presentation was an infant that had
been crying in an inconsolable manner and upon
careful examination was found to have a digit
or a body part entangled by a hair or a textile
thread causing a tourniquet like effect but our
case was unique as it was an incidental finding.
Case Report: This case reports a 5 months old
healthy female child that was accidentally found
to have a hair wrapped around her left fourth
toe on her regular routine vaccination visit.
Conclusion: This presentation is quite different
than the presentation usually encountered or
those presented previously in literature. The
diagnosis of the syndrome requires a high index
of suspicion, it may present a diagnostic dilemma
therefore through awareness of the condition is
important.
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NewsBot · Aug 4, 2019

Toe-Tourniquet Syndrome; A Previously Unreported
Association in Extreme Prematurity
Aarti Verma, Reham Hashem and Ghada Ramadan
EC Paediatrics 8.8 (2019): 693-695.

Toe-tourniquet syndrome is a condition caused by hair or fibrous strands encircling a digit. It can lead to compressive oedema,
ischaemia and potential loss of an appendage. The condition constitutes a surgical emergency requiring immediate intervention. We
report a 23+5 weeks gestation infant weighing 545 grams at birth who was admitted to a tertiary neonatal unit for medical management of respiratory distress syndrome. The infant developed toe-tourniquet syndrome on day 18 after birth. This complication
presented as ischaemic swelling of the second and third toes of one limb with the constricting fibres arising from the infant’s wool
blanket. Restoration of the infant’s toes circulation and full recovery was achieved after manual removal of the bands. We would like
to raise awareness of this condition which has not been described in extremely preterm infants previously. This is to prevent potential complications relating to wool blankets which are commonly used in neonatal units.
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NewsBot · Dec 20, 2019

Hair Thread Tourniquet Syndrome in an Infant: Emergency Exploration Saves Limbs
Levin Kesu Belani , Juzaily F. Leong, Parminder Singh Gill Narin Singh, Shalimar Abdullah
Cureus 11(12): e6377. doi:10.7759/cureus.6377

Hair thread tourniquet syndrome (HTTS) is a rare condition where fibres constrict around appendages causing ischaemia and necrosis. It is a sporadically reported condition, where almost all reported cases showed involvement of fingers, toes or genitalia. A significant number of the cases are infants aged two weeks to six months where it is attributed to the mother’s excessive hair fall due to hormonal changes after delivery. We present a two-month-old infant who was irritable for the past two days with her left ring finger exhibiting an ischaemic constriction with no apparent insulting agent. She successfully treated surgically after we suspected an incomplete removal of hair thread in the emergency department. We would like to highlight the importance of a high index of suspicion in cases as such as early intervention saves the appendage.
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NewsBot · Mar 5, 2020

Hair thread tourniquet syndrome in an eight month old
infant
Rafet Ozbey
Annals of Medical Research;27(1):399-400

Circulating hairs or threads may cause hair-thread tourniquet syndrome in babies and mentally retarded individuals. Although it is
mostly seen in the fingers and toes, it can be seen in the penis, clitoris, and labium and uvula. It may result in loss of the limb if it’s not
recognized early and is not treated correctly. In this study, the case of the second toe of the left foot was presented. Eight month old
boy presented with complaints of restlessness and crying for 2 days. Physical examination revealed a constrictive band surrounding
the proximal phalanx second toe of the left foot. There was no evidence of child abuse from the family history. It is recommended
to make a longitudinal deep incision where there is coiling of the finger. Wrapped hair thread were removed and treated with a small
and deep incision dorsally under local anesthesia as described by Serrour. Amoxicillin clavulanic acid was given orally as antibiotic.
The wound was healed without any problem by dressing with antibiotic creams for 10 days. In conclusion, it is important to keep
this syndrome in mind in patients presenting with the mentioned complaints, in terms of diagnosis and recovery of limb with early
treatment.
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NewsBot · Sep 21, 2021

Treatment of a Case of Toe Hair-Thread Tourniquet Syndrome With Hirasè Technique
Federico Tamborini et al
Pediatr Emerg Care. 2021 Sep 14

Hair-thread tourniquet syndrome (HTTS) is an uncommon condition that affects mostly babies, usually a few months old. It happens when a strand of hair or cloth fiber encircles an appendage causing a condition of total or subtotal ischemia (West J Med 1976;125:335-336). This condition has been described several times in the recent literature. Appendages involved include toes, fingers, genitalia, uvula, and neck (N Engl J Med 1965;273:866-867). The mechanism of injury usually involves the fiber cutting the skin deeply through soft tissues, veins, and arteries. As HTTS occurs in small babies and hidden parts of the body, sometimes this event can be very difficult to detect and irritability may be the only symptom. The treatment consists of releasing the circumferential constriction and restoring the arteriovenous flow also with microsurgical techniques if vessel interruption is present. Unfortunately, the fiber or the thread often penetrates so deep that, once an HTTS is recognized, it may be very challenging to identify and trim. The authors present a case of HTTS of the second toe of the right foot in a 2-month-old baby treated with surgical release and Hirasè technique. After the thread was successfully cut and removed, the forefoot was covered with aluminum foil, and a bag with ice was immediately put all around. After 3 days, we observed a complete survival of the toe without any sign of necrosis. Later control at 6 months showed complete restitutio ad integrum of the affected digit with a normal perfusion and absence of any onychopathy. Hirasè technique represents a simple, safe, and low-cost option of treatment for HTTS.
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NewsBot · Jun 12, 2022

Hair thread tourniquet syndrome. Case reports and case series review.
Martonovich N., Alfandari L., Paz I., Behrbalk E.
Eur. J. Pediat. Dermatol. 32 (2):83-90. 10.26326/2281-9649.32.2.2351.

Introduction. Hair thread tourniquet syndrome is a phenomenon that occurs among infants. A human hair strangulates a body appendage and causes focal edema followed by ischemia. It is a relatively uncommon phenomenon and the literature consists mainly of case reports and case series.
Materials and methods. Conducting plural searches in the literature published up to 2021. Using keywords that serve as synonyms of this condition: hair thread tourniquet, hair strangulation, external constriction on the toe. Articles regarding non-digits hair tourniquet syndrome were excluded.
Results. Among 146 relevant articles, 49 case reports and case series were extracted. A total of 78 individual cases were examined:
Patients’ gender: 35 males, 33 females, and 10 cases did not mention the gender
Patients’ age: the age range is 12 days to 6 years, the majority were between 3 to 5 months.
In 66 cases toes were involved, and in 9 cases fingers were involved.
Discussion. According to the data, there is a higher incidence rate of the phenomenon around 3 to 5 months. This might be explained by the maternal tendency to lose hair (post-partum telogen effluvium or post-partum alopecia). This reaches its peak around 4 months post-partum. No gender is at higher risk. Toes are significantly more involved than fingers and the most frequent toe involved was the third.
There is a lack of demographic data regarding this syndrome, further multi-central cohort studies are recommended.
Conclusions. Infants between 2-6 months are at greater risk. There is no up-to-date demographic data regarding this condition.
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NewsBot · Mar 15, 2023

Diagnosis and Treatment of a Nonhealing Wound Secondary to a Reepithelialized Hair Tourniquet With Ultrasound.
Chwa ES et al
The Journal of Craniofacial Surgery, 13 Mar 2023,

A 9-month-old girl presented with a chronic wound on the dorsal surface of her toe that failed 6 months of medical management. Due to the prolonged clinical course, there was a concern for a foreign body. Intraoperative ultrasound was utilized to identify linear echogenic structures, which were excised and consistent with reepithelialized hairs secondary to hair-thread tourniquet syndrome. There were also erosive changes to the underlying phalanx. Intraoperative ultrasound was also used to guide the incision size and confirm the complete removal of the hairs.
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NewsBot · Aug 10, 2023

Hair tourniquet syndrome of toe
Muhammed Köroğlu et al
Foot and Ankle Surgery 28 June 2023

Introduction
Hair tourniquet syndrome (HTS) is a rare surgical emergency caused by a hair or thread wrapping around an appendage. We aimed to present our clinical experience with HTS of toes and attract physicians’ attention to this rare entity.

Methods
Between January 2012 and September 2022; 26 patients (25 pediatric and one adult case) were treated for HTS. All pediatric cases were treated surgically under loop magnification. The adult patient was treated nonsurgically. The patient’s age, gender, affected appendage and side, duration of symptoms, and postoperative complications were recorded.

Results
Thirty-six toes of 25 patients (13 boys, 11 girls, and a male adult) were included in the study. The mean age of pediatric patients was 126.6 days. The third toe was the most affected (n:16), followed by the fourth (n:8). In seven patients more than one was affected.

Conclusion
HTS should be treated as soon as possible when diagnosed to prevent further complications including appendage loss.
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NewsBot · Apr 24, 2024 at 2:54 AM

Hair-thread Tourniquet Syndrome: Two Case Reports and Review of the Literature
Evin, Nuh; Gasimov, Joshgun; Demir, Fatih Osman; Erbayat, Yusuf
Turkish Journal of Plastic Surgery 32(2) 77-79, Apr–Jun 2024.

Hair-thread tourniquet syndrome (HTTS) is an emergency phenomenon in which hair or thread tightly wraps around a protruding appendage of the body, resulting in pain, swelling, and rarely ischemia and amputation. While the toes, fingers, and external genitalia are the most affected areas, it can also impact other protruding parts of the body. Nevertheless, except for a few cases of skin tags and hemangioma, HTTS associated with a protruding skin mass is extremely rare in the literature. In this study, we present the management of two cases: One involving a pediatric patient with HTTS affecting the right fourth toe and the other involving a protruding pyogenic granuloma on the back of an adult patient.
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