Article

Hair Tourniquet Management

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Unwind or incise has been the standard of management for removing hair tourniquets. The hair ends are usually difficult to hold and unwind as they break at the ends easily, and using scalpels or needles to get under the hair tourniquet is difficult when the involved appendage is swollen and leads to more trauma to the injured area. This is the first case report that describes the removal of hair tourniquet using a depilatory cream.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... However, this procedure is quite difficult and painful because of the toe oedema. O'Gorman and Ratnapalan [11] indicated that depilatory agents may be useful in patients who do not have ischaemic findings. The depilatory agents destroy the disulfide chains in the hair and was proven to be successful in two-thirds of their cases [11]. ...
... O'Gorman and Ratnapalan [11] indicated that depilatory agents may be useful in patients who do not have ischaemic findings. The depilatory agents destroy the disulfide chains in the hair and was proven to be successful in two-thirds of their cases [11]. When removal is unsuccessful, the strangulation should be relieved by making one or two dorsal longitudinal incisions on the toe [1,12]. ...
Article
Full-text available
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.
... SEM permits the analyst to extensively and concurrently investigate a perplexing model with various autonomous and nonautonomous factors [26]- [30]. Therefore, information system (IS), business management, and social science researchers utilise this strategy [33] extensively [34], portrayed that: from 1998 to 2007, 33.3% of journals in the ISR, 34.5% in the JMIS, and 32.2% papers used SEM methods. McDonald and Ho stated that the partial least squares (PLS) approach is viewed as the most exhaustive and an expansive strategy. ...
... With an intention to test the proposed speculations, SEM is utilized to evaluate an exploration model and empower to execute different complex measurable examinations rapidly. It is a regression-based methodology that characterizes the relationship among the observed factors [33] and targets to limit the remaining variances of endogenous factors [34]. For estimating our model here SEM with the PLS procedure [35] and SmartPLS3 software is utilized to compute the data. ...
Article
Full-text available
p> The present study has been conducted to examine whether skills and general technology-related value (GTV) required to operate the internet of things (IoT). This study also investigates is there any effect of technophilia to adopt IoT. The research method we use in this quantitative study was the sample survey. For investigating results, 352 surveys were conducted where 26 surveys were led through online and 292 surveys were distributed to different age groups. The proposed model was examined using partial least square structural equation model where the results revealed that IoT skills and General knowledge on technology directly contribute to technophilia which covers behavioural, emotional, and cognitive aspects. That is if people have a fascination for new technologies then they are willing to use IoT. </p
... It was first described in 1612 by Guillemeau and first appeared in the literature in The Lancet in 1832 [1]. It has multiple pseudonyms such as hair wrapping, hair tourniquet, and hair thread constriction but the term hair thread tourniquet syndrome was first used by Barton et al. in 1988 [1,[2][3][4]. Hair thread tourniquet syndrome is described as when hair (or textile thread) wraps around one or multiple distal appendage/s with an end arterial supply, acting as a ligature causing partial or total circulation loss to the distal part. This, in turn, leads to ischaemia, necrosis, and loss of distal appendages with associated complications unless prompt management is undertaken [4,5]. ...
... The hair can cut through the epithelium and re-epithelialisation over the hair may occur, making visualization of the hair and therefore, diagnosis surprisingly difficult [5]. The basis of the management is the removal of the tightly bound hair and this can be done by unwrapping, cutting or dissolving the offending fibre, and return of circulation [3,6]. As such, this should be treated as an avascular emergency however, it is frequently overlooked or mismanaged. ...
Article
Full-text available
Hair thread tourniquet syndrome is a rare but previously well-documented presentation. It is described as circumferential strangulation of distal or multiple distal appendages, which can lead to tissue ischaemia and eventually necrosis without prompt treatment. Despite the characteristic presentation and potential for serious complications, many healthcare professionals remain unaware of hair tourniquet syndrome and the need for urgent management. We present the case of a 9-month-old infant who presented to the emergency department. The parent noted a long hair emanating from the mouth but on attempts to remove it was unable to do so. The child was otherwise stable. Examination on the oral cavity revealed the hair strand tightly wrapped around an oedematous and congested uvula. Attempts to remove the ligature in the emergency department were unsuccessful and a subsequent referral to otolaryngology was made. A decision was made to take the child to the operating theatre, where the ligature was successfully removed with the distal uvula remaining viable.
... Treatment of HTS may be performed by removing the hair surgically or by using chemical depilatories. 6,11,12 Chemical depilatories can be used especially for superficial hairs and should not be used near mucous membranes (e.g. female genitalia). ...
... female genitalia). 6,11 Chemical depilatories break the disulfide bonds in hair. 6 Furthermore, more than two interventions with depilatories are not recommended. ...
Article
Full-text available
Objective: Hair tourniquet syndrome is an uncommon condition characterized by strangulation appendages by a hair or thread. The aim of this study was to evaluate the results of hair removal and antibiotic therapy in our patients with hair tourniquet syndrome. Methods: Between January 2012 and August 2018, 16 patients (8 boys, 8 girls; mean age: 118.5 [range: 20 to 380] days) were treated surgically for hair tourniquet syndrome. All patients were treated surgically under local or general anesthesia in the pediatric emergency department or in the operating theater using magnifying loupes. The age, gender, affected fingers or toes and the affected sides of the patients and the duration of symptoms until presentation were recorded. Results: A total of 24 toes and fingers were treated for hair tourniquet syndrome. The right side was affected in 12 patients, the left side was affected in three, and both sides in one. The second toe was affected in three patients, the third toe in eleven, the fourth in six, and the fifth in two patients. Both the thumb and the second finger were affected in one patient. The average duration of the symptoms (excessive crying, swelling, redness) was 1.5 (range: 1 to 2) days. All patients healed without any complications. Conclusion: Hair tourniquet syndrome should be kept in mind as an etiology in infants with toe and finger strangulation. These patients should be examined undressed. Immediate removal of hair is an effective treatment method to save appendage. Level of evidence: Level IV, Therapeutic Study.
... Subsequently, the area should be washed thoroughly. Following a reviewing of the literature regarding the use of depilatory agents for the treatment hair tourniquet syndrome, we found only one case report describing the use of technique in which O'Gorman et al described one baby with hair tourniquet syndrome who was successfully treated with a depilatory agent [20]. We reported these cases to encourage the use of this safe, painless and non-invasive method when allowed for by the conditions of the patient allows. ...
Article
Full-text available
KEYWORDS Hair tourniquet syndrome; Management of hair tourniquet syndrome; Hair tourniquet removal Abstract Hair tourniquet syndrome is a clinical phenomenon that involves hair or thread becoming so tightly wrapped around an appendage that pain, swelling and occasionally ischemia result. We report two cases of hair tourniquet syndrome that affected the digits and were treated with hair removal cream, which was an easy, effective and less invasive treatment method compared with standard managements such as incision or blunt probe cutting techniques.
... Subsequently, the area should be washed thoroughly. Following a reviewing of the literature regarding the use of depilatory agents for the treatment hair tourniquet syndrome, we found only one case report describing the use of technique in which O'Gorman et al. described one baby with hair tourniquet syndrome who was successfully treated with a depilatory agent [20]. We reported these cases to encourage the use of this safe, painless and non-invasive method when allowed for by the conditions of the patient allows. ...
Article
Full-text available
Hair tourniquet syndrome is a clinical phenomenon that involves hair or thread becoming so tightly wrapped around an appendage that pain, swelling and occasionally ischemia result. We report two cases of hair tourniquet syndrome that affected the digits and were treated with hair removal cream, which was an easy, effective and less invasive treatment method compared with standard managements such as incision or blunt probe cutting techniques.
... Constriction band in such cases can be removed by inserting a probe between constrictor and body tissue and unwinding the hair or can be cut by inserting a small seizure between skin and hair and cutting the constriction band [15]. Depilatory agents have also been used to remove hair as constriction bands without causing any pain to the patients [15,16]. However for the patients who present late constriction band is embedded into deeper tissues, re-epithelization of skin across the wound and gross swelling of the area makes constriction band invisible to naked eyes. ...
Article
Full-text available
Background: Long harsh winter in Kashmir Valley increase the incidence of pernio in children so much that common people consider every hand swelling as pernio. Methods: 10 Infants over two years were brought to our hospital as cases of pernio involving fingers. Results: All the infants came out to be cases of impending gangrene due to mother's hair as constriction bands around fingers. Conclusion: Impending gangrene of fingers in infants due to mother hair as constriction band is very rare. However its symptoms overlap with symptoms of peripheral cold injuries and can be easily mistaken for each other by people.
... Additional antibiotic treatment is required if necrosis or infection of the affected appendages is evident. Further, O'Gorman and Ratnapalan [14] reported the treatment of hair tourniquet syndrome using a depilatory cream in cases in which unwinding of the hair is difficult. Neglect of this condition may lead to dire consequences, including autoamputation of vital body appendages. ...
Article
Full-text available
Hair tourniquet syndrome refers to the strangulation of appendages by a thread of human hair. This condition can lead to ischemic injury of these appendages. Thus, to avoid constrictive injury, prompt recognition and treatment are very important. Affected areas include fingers, toes, and genitalia. Hair tourniquet syndrome involving the labium minora is extremely rare. We here report a case of hair tourniquet syndrome involving the labia minora in an 11-year-old girl.
... Reported techniques of surgical intervention include unwrapping method in cases with minimal edema, cutting of encircled hair with scissors or scalpel blade. Although its usage is off-label, use of depilatory creams has been reported to be safe alternative to instrumentation with minimal discomfort [22]. Cases requiring surgical debridment have also been reported for the treatment of late diagnosed patients with HTS [1,23]. ...
Article
Full-text available
Hair tourniquet syndrome (HTS) ia a rare clinical phenomenon. In this condition, a body appendage is tightly and circumferentially wrapped by hair, thread or similar material. Commonly affected sites include fingers, toes and genitals. Prompt diagnosis and treatment of this condition is vital to attain good outcome and prevent even a catastrophic consequence of autoamputation in affected body part. We here report a case of HTS involving genitalia in a 8-year-old girl. It is also aimed in this report to review current information about management of HTS in the light of relevant literature.
... Some physicians advocate the use of depilatory creams to dissolve the hair to induce less trauma if there is no immediate vascular compromise. Specifically, in one report, an over-the-counter depilatory cream (active ingredient: calcium thioglycolate) was applied over the digit and left for thirty minutes, after which the cream was gently rubbed off and the digit washed in warm water [5]. However, edema and reepithelialization may hinder the methods described above and a surgical intervention may be required under local or general anesthesia. ...
Article
Hair-thread tourniquet syndrome (HTTS) is caused by circumferential constriction of an appendage, usually by hair or thread, leading to obstruction of circulation and ischemia. Although not rare, this entity is not discussed extensively in the Dermatology literature. We present a case of HTTS and discuss the demographics and etiology, and review the most current treatment methods.
... Boğuma neden olan saç tellerinin parmaktan uzaklaştırılması tedavide esastır. Bu işlem bir penset yardımıyla tutulan saç tellerinin ters yöne döndürülmesiyle ya da tüy dökücü krem uygulanarak cerrahiye gerek duyulmadan da yapılabilmektedir [6]. Ancak bizim olgumuzda olduğu gibi saç telleri cilt içine gömülü olup makroskopik olarak görülemediğinde, literatürde sıkça uygulanan, dolaşımı akut olarak düzelten parmak dorsalinden kemiğe kadar ilerletilen cilt kesisini tercih etmek gerekir [7]. ...
... Boğuma neden olan saç tellerinin parmaktan uzaklaştırılması tedavide esastır. Bu işlem bir penset yardımıyla tutulan saç tellerinin ters yöne döndürülmesiyle ya da tüy dökücü krem uygulanarak cerrahiye gerek duyulmadan da yapılabilmektedir [6]. Ancak bizim olgumuzda olduğu gibi saç telleri cilt içine gömülü olup makroskopik olarak görülemediğinde, literatürde sıkça uygulanan, dolaşımı akut olarak düzelten parmak dorsalinden kemiğe kadar ilerletilen cilt kesisini tercih etmek gerekir [7]. ...
... Early diagnosis of HTS can be challenging, however, because the symptoms in infants with toe HTS are non-specific, and school-aged children and adolescents with genital HTS are often reluctant to inform their parents about the problem. 3,4 Thus HTS can be considered as the differential diagnosis of unexplained crying in infants and genitourinary symptoms in school-aged children or adolescents. 1 There is a high index of suspicion for HTS in these cases, and early diagnosis and treatment are warranted. ...
... Therefore, it is reccomended to remove it in operation room (14). It has been reported that hair tourniquet syndrome may be successfully treated by using depilatory (15). Topical or systemic antibiotic is generally used after operation (11,13,14). ...
Article
Full-text available
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.
... There are various techniques of surgical intervention reported in the literature and these are detaching if there is minimal edema, cutting out of the tight stretched hair with scissors or scalpel blade. Depilatory creams are safe choice of treatment and they do not produce any discomfort but their usage is not approved [22]. Especially in late diagnosed patients having HTS surgical debridement is another option [1,23]. ...
Article
Full-text available
Hair tourniquet syndrome (HTS) is a rare condition and may pose diagnostic dilemma. The purpose of this study is to report our experience in 3 female cases with HTS involving genitalia. All the patients in this series presented with swollen and edematous genitalia and clitoris accompanied by strangulation in clitoris or labia minora with a hair thread. Strangulating hair was excised and removed under local anesthesia. The pain was cleared away and edematous discoloration disappeared immediately. Local application of antibiotic ointment was added to the treatment in these cases for a period of 6-7 days. The anatomy of the genitalia was found to be normal in these children during the follow up exam. A brief literature review on this subject is also given in this review.
... If the constricting agent is hair, the use of a depilatory agent is possible with minimal discomfort to the child [6]. However, it may not be suitable in cases where the hair is deeply embedded and unable to be visualised [7]. ...
Article
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.
... There are various techniques of surgical intervention reported in the literature and these are detaching if there is minimal edema, cutting out of the tight stretched hair with scissors or scalpel blade. Depilatory creams are safe choice of treatment and they do not produce any discomfort but their usage is not approved [22]. ...
Article
Full-text available
Hair tourniquet syndrome (HTS) may be a challenge to the pediatrician. In this condition, a body appendage is firmly encircled by a various materials in a circular manner. These materials can be hair, thread or similar object. Most sites of involvement in body are fingers, toes and genitals. In order to attain favourable outcome and avoid hazardous consequences of this rare disease such as au-toamputation in affected body part, prompt diagnosis and treatment is vital. The purpose of this study is to review the characteristics of HTS and its management options with a brief literature review.
... Depilatory cream, with the active ingredient calcium thioglycolate, can be applied to the affected extremity and then removed by gentle washing after several minutes (9). Application of depilatory cream has been successful in 64% of cases, some needing a second application of the cream (10). ...
Article
Full-text available
Penile strangulation is a rare condition in children caused by circumferential constriction of the coronal sulcus by constricting material, commonly thin maternal hair. Vague presenting symptoms often makes diagnosis difficult, but delay in diagnosis can lead to a variety of severe complications including urethral injury and penile necrosis. Providers must have a high index of suspicion and carry out a careful examination to identify maternal hair strands that may bury deep within penile edema. We describe two cases of penile strangulation secondary to maternal hair strands that were successfully treated with thorough examination and division of the constricting hair in the emergency department. In both cases, presentation involved penile swelling and erythema which was noticed by caregivers. Once the diagnosis has been made, urgent treatment using depilatory cream or mechanical removal must occur, with urgent referral to specialists if unable to remove to constricting material. Caregivers must also be counseled on appropriate steps to prevent penile hair tourniquet syndrome. Devastating complications can be avoided by early recognition and proper management of the syndrome, but providers must have knowledge of the condition and a high index of suspicion.
... Some authors suggest that techniques using scalpels or needles to get under the hair tourniquet are difficult because of the swelling; the risk of damaging healthy tissues is high [8]. O'Gorman and Ratnapalan [9] used a depilatory cream to destroy such hair, concluding that this is safe and can be performed with minimal discomfort to the patient. However, this technique cannot be used if the hair fibers are deeply embedded in the edematous skin and not clearly visible; we do not suggest the use of creams if there are wounds or deep-tissue exposure. ...
Article
Full-text available
Hair toe tourniquet syndrome (HTTS) is an uncommon pediatric condition occurring when the toe is circumferentially strangulated by human hair or fibers. An 8-week-old little girl was admitted to the Emergency Department because of the worsening swelling in the right second and third toes, which had been been previously treated with a local antibiotic thinking of an infection. An unrecognized HTTS was leading the third toe to necrosis. An urgent release of the constricting band on the two toes was performed and bone erosion and partial flexor tendon lesion on the third toe were detected. We would like to raise awareness in the community and in colleagues about HTTS in children, because early recognition and urgent treatment are mandatory to provide an adequate management and prevent severe complications.
Article
Study objective: We examine the ability of a depilatory agent, Nair, to dissolve strands of hair, cotton, polyester, and rayon. Methods: We conducted a bench laboratory study in which we tested single strands of hair and natural and synthetic fibers under static tension with a 10.8-g weight and application of Nair. The dependent variable, time until breakage, was recorded. If the strand did not break within 8 hours, the experiment was discontinued. Three types of hair were tested (thin, medium, and thick, as recorded per diameter). Three types of natural and synthetic fibers were tested (cotton, polyester, and rayon). Results: All types of hair had breakage within 10 minutes of the Nair application. Synthetic materials had no breakage after 8 hours with application of Nair. Conclusion: Depilatory agents dissolve hair under tension within minutes. However, they do not dissolve cotton, polyester, and rayon even after many hours of application.
Article
In a two-month-old girl, a red edematous toe with risk of gangrene was noticed. The affected toe had been encircled by a strangulating thread, which was removed under general anesthesia. The child fully recovered. The toe tourniquet syndrome is a relatively unknown condition, most common in babies of only a few months old. It occurs when an encircling hair or thread partially or fully obstructs the blood circulation to the toe, provoking swelling and discoloring of the area distal to the constriction. Apart from the tourniquet syndrome of one or more toes, cases have been described involving strangulation of the fingers, the genitals and (less common) the uvula or the neck. A prompt diagnosis and intervention are necessary to prevent necrosis of the encircled appendage. If the strangulation is removed promptly, a complete recovery may be expected.
Article
Hair tourniquet syndrome is rare, referring to a condition when hair, thread or fiber wraps tightly around an infant's appendage causing a tourniquet effect, carrying a potential risk of permanent tissue damage or loss of appendage secondary to the strangulation. We report a young infant having hair tourniquet syndrome at the toe, with complete removal of the offending hair resulting in full recovery, however, no explanation for the strangulation identified. Possibility of child abuse and neglect has to be seriously considered for most if not all cases.
Article
Full-text available
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.
Article
Full-text available
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.
Article
Background Hair-thread tourniquet syndrome (HTTS) is the constriction of an appendage or tissue by a hair thread, which can cause ischemia and necrosis of distal tissues. Depilatory agents have the potential to release the hair tourniquet without exposing the patient to the risks of surgery. Objectives: This review aims to evaluate the effectiveness, benefits, complications, and contraindications of depilatory agents in HTTS. Methods: Relevant terms to HTTS and depilatory agents were used to search for articles on MEDLINE and EMBASE databases using the NHS Healthcare Databases Advanced Search engine. Results: In total, 19 of the 295 articles identified in the primary search were included in the final review. Articles described the benefits of depilatory agents as painless, well tolerated, and non-invasive. Contraindications described include use on mucosal membranes, non-hair tourniquet, and allergy. Sixty-four percent (n = 55) of patients had resolution of their HTTS after one or two cycles of depilatory agent treatment. Conclusions: The use of depilatory agents has multiple potential benefits. The authors propose a treatment algorithm for the use of depilatory agents in HTTS and recommend that all acute centers should store and train staff in their use.
Article
Hair-thread tourniquet syndrome is a rare, painful condition that occurs when a strand of hair or thread becomes wrapped around toes, fingers, or other appendages. This causes focal edema, which eventually reduces arterial blood flow and can lead to ischemia and necrosis. A thorough physical examination and assessment of risk factors are important. Treatment involves depilatory agents or targeted incision at the bedside or in the operating room. Successfully treated cases can be discharged with local wound care. Parents should be advised on prevention strategies and ensure close follow-up for reexamination.
Article
Oral foreign bodies and hair-thread tourniquets are fairly common findings. The combination of the two, however, is rarer. In this article, we present a case involving a hair-thread tourniquet of a circumvallate papillae (more commonly known as a "taste bud"). We discuss methods for removal of hair-thread tourniquets as well as techniques for examining children for oral foreign bodies.
Article
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.
Article
Hair-thread tourniquet syndrome is a rare condition where appendages are strangulated by an encircling strand of hair, a thread, or a fiber. The condition usually occurs in very young patients in the first few months of life. We present a unique case of a 3-month-old baby girl with hair-thread tourniquet syndrome in whom a hair cheese-wired through the skin and soft tissue of the toe and caused bony erosion of the underlying phalanx. An extensive literature review and meta-analysis of the topic are also presented.
Article
The "toe tourniquet syndrome" is the circumferential strangulation by human hair or fibers of one or more toes in infants, which may induce prolonged ischemic injury and tissue necrosis. Release of the strangulation is mandatory to avoid autoamputation of the digit. We recently encountered several incompletely treated cases and would like to emphasize the effective method of treatment. A retrospective analysis of pediatric emergency department records of patients treated for "toe tourniquet syndrome" during 1990 to 2001 was performed. Patients undergo a short, longitudinal, deep incision over the area of strangulation on the dorsal aspect of the toe, until the phalanx bone, which allows the complete section of the constricting fibers to be removed without injury to the anatomical structures of the toe. Twenty-one infants (12 boys and nine girls), aged 0-11 months (average 4.6 months), were treated for tourniquet syndrome of one (15 infants) or two (six patients) toes. In 12 patients (57.1%) the right foot was involved. Eight patients (38.1%) had undergone an attempt in the previous few days to release constriction. No complications were encountered. The above-described technique is simple and safe and secures the complete release of the strangulation by removal of all hairs or fibers without injury to the anatomical structures of the toe.