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CASE REPORT
Year : 2017  |  Volume : 30  |  Issue : 4  |  Page : 1260-1261

Hair tourniquet syndrome: A rare case report


Department of Pediatric Surgery, S.M.S. Medical College and Group of Hospitals, Jaipur, Rajasthan, India

Date of Submission31-Jan-2017
Date of Acceptance19-Mar-2017
Date of Web Publication04-Apr-2018

Correspondence Address:
Aditya P Singh
Department of Pediatric Surgery, S.M.S. Medical College and Group of Hospitals, Jaipur - 302 004, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_111_17

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  Abstract 


Hair tourniquet (HT) syndrome is a rare disorder. Although most cases are considered to be accidental, child abuse must be considered in selected cases. HT syndrome involving the toes occurs during the time period when post-partum mothers are experiencing increased hair loss. In this article, we report a rare case of HT in a 1.5-month-old male child.

Keywords: constriction, gangrene, hair, thumb


How to cite this article:
Singh AP, Tanger R, Mathur V, Gupta AK. Hair tourniquet syndrome: A rare case report. Menoufia Med J 2017;30:1260-1

How to cite this URL:
Singh AP, Tanger R, Mathur V, Gupta AK. Hair tourniquet syndrome: A rare case report. Menoufia Med J [serial online] 2017 [cited 2020 Feb 17];30:1260-1. Available from: http://www.mmj.eg.net/text.asp?2017/30/4/1260/229196




  Introduction Top


The impending gangrene of the thumb in infants is rare. Our case was interesting because there is a paucity of data in the literature about gangrenes secondary to constriction of a finger caused by the mother's hair. Finger and toe gangrenes are uncommon in the pediatric age group [1–3]. As the old saying goes, prevention is better than cure, and fortunately, in our case the use of prompt measures designed for the timely removal of the hair strand causing the constriction prevented any further establishment of gangrene that could have led to amputation.


  Case History Top


Parents of a 1.5-month-old male baby presented to us with complaints of persistent erythema, constriction band, and swelling affecting the right thumb. The baby was born at 39 weeks of gestation to a 24-year-old primigravida. The patient was the first child of nonconsanguineous parents.

There was no history of similar problems. The mother had a history of hair fall. Routine blood investigations were normal. There was no history of injury or local application of any medicine on the thumb. Neither the history of the child nor of the parents was significant; there was no history of peripheral gangrene in the family. On inspection, the right thumb was red, swollen, and tender with a constriction ring [Figure 1]. On further examination, a single, tightly entwined hair was found in the constrictions of the right thumb [Figure 2]. The hair was removed with fine forceps. The color and swelling improved overnight, and the child was discharged home in the morning. No further problems were reported 1 month following this episode [Figure 1] and [Figure 2].
Figure 1: Photo showing erythema, a constriction band, and swelling in the right thumb.

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Figure 2: Right thumb showing a constriction band with hair encircling it.

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  Discussion Top


Hair tourniquet (HT) syndrome has been described to involve the fingers, the toes, and even the genitals[4],[5]. The majority of cases of HT syndrome have been reported in infants less than 2 months of age[6]. This condition is also known as toe tourniquet syndrome[7]. Circumferential digital strangulation impairs lymphatic and venous drainage causing distal edema. Further obstruction may cause arterial occlusion and ischemic injury[8]. Prolonged ischemic injury leads to tissue necrosis and ultimately autoamputation. Treatment is prompt removal of the constricting hair or fiber. It can usually be removed by direct inspection. Surgical exploration is mandatory if doubt persists as to the completeness of removal, especially as the hair cuts through the skin and becomes invisible[4],[8].

Gangrene in neonates is a rare event. The etiology is not identified in most cases, and management is usually conservative, with debridement and amputation of the gangrenous part involving toes.

Gangrenes result from diminished perfusion to a part of the body, usually the extremities. Known etiologies include a hypercoagulable state, in-utero arterial thrombosis, polycythemia, maternal diabetes, congenital bands, birth trauma, prematurity, congenital syphilis, umbilical artery cannulation, intravenous hyperosmolar infusions, and sepsis[9],[10],[11],[12].

Toe tourniquet syndrome is a rare and dangerous but a preventable condition of young infants. Prompt diagnosis and treatment of the condition are vital to attain a good outcome and prevent further harm to the child. New parents should be warned that if excessive hair loss should occur then their infant should be carefully checked on a regular basis to make sure that no hair strands are getting entangled in the fingers or toes.


  Conclusion Top


Impending gangrene secondary to the mother's hair is extremely rare. Fortunately, the prompt use of measures and timely removal of the hair strand causing constriction in our case prevented gangrene formation that would have led to amputation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Turnpenny PD, Stahl S, Bowers D, Bingham P. Peripheral ischaemia and gangrene presenting at birth. Eur J Pediatr 1992; 151:550–554.  Back to cited text no. 1
    
2.
Kothari PR, Gupta A, Kulkarni B. Neonatal lower extremity gangrene. Indian Pediatr 2005; 42:1156–1158.  Back to cited text no. 2
    
3.
Carr MM, Al-Qattan M, Clarke HM. Extremity gangrene in utero. J Hand Surg Br 1996; 21:652–655.  Back to cited text no. 3
    
4.
Alverson B. A genital hair tourniquet in a 9-year-old girl. Pediatr Emerg Care 2007; 23:169–170.  Back to cited text no. 4
    
5.
Barton DJ, Sloan GM, Nichter LS, Reinisch JF. Hair-thread tourniquet syndrome. Pediatrics 1988; 82:925–928.  Back to cited text no. 5
    
6.
Sudhan ST, Gupta S, Plutarco C. Toe-tourniquet syndrome – accidental or intentional? Eur J Pediatr 2000; 159:866.  Back to cited text no. 6
    
7.
Strahlman RS. Toe tourniquet syndrome in association with maternal hair loss. Pediatrics 2003; 111:685–687.  Back to cited text no. 7
    
8.
Mackey S, Hettiaratchy S, Dickinson J. Hair-tourniquet syndrome – multiple toes and bilaterality. Eur J Emerg Med 2005; 12:191–192.  Back to cited text no. 8
    
9.
Musa AA. A review of diagnosis and modes of presentation of tropical idiopathic lower limb gangrene. Afr Health Sci 2006; 6:49–50.  Back to cited text no. 9
    
10.
Krishnamurthy S, Singh V, Gupta P. Neonatal frostbite with gangrene of toes. Pediatr Dermatol 2009; 26:625–626.  Back to cited text no. 10
    
11.
Giannakopoulou C, Korakaki E, Hatzidaki E, Manoura A, Aligizakis A, Velivasakis E. Peroneal nerve palsy: a complication of umbilical artery catheterization in the full-term newborn of a mother with diabetes. Pediatrics 2002; 109:66.  Back to cited text no. 11
    
12.
Ibrahim H, Krouskop R, Jeroudi M, McCulloch C, Parupia H, Dhanireddy R. Venous gangrene of lower extremities and Staphylococcus aureus sepsis. J Perinatol 2001; 21:136–140.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]



 

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Abstract
Introduction
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Discussion
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