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Hair Tourniquet

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Hair Tourniquet, Tourniquet Syndrome

  • See Also
  1. Unconsolable Infant
  • Definitions
  1. Hair Tourniquet
    1. Hair, thread or fiber wrapped tightly around appendage (i.e. finger, toe, penis, clitoris)
    2. Typically limited to infants, young children and cognitively impaired children
  • Pathophysiology
  1. Hair Tourniquet pain results from cutting into skin or constricting flow
  2. Hair Tourniquet may result in local ischemia and Skin Erosions and Lacerations
  • Epidemiology
  1. Typically limited to infants (esp. months 2 to 5 of life)
    1. Most common at maximal maternal postpartum, hormonally-induced Hair Loss
  2. May also affect cognitively impaired children
  • Symptoms
  1. Unconsolable Infant with pain and irritability
  • Signs
  1. Proximal ligature (hair, thread, fiber)
  2. Erythematous, swollen distal digit or penis
  • Management
  1. Topical depilatory agent (e.g. Nair, Veet)
    1. First-line measure when available
    2. Apply to Hair Tourniquet
    3. Avoid depilatory agents on mucosal surfaces (e.g. female genital tract such as clitoral Hair Tourniquet)
    4. Works slowly to dissolve natural hair
      1. Depilatory agents contain thioglycerates that break the disulfide bonds in hair
      2. Works only with natural hair (not effective for synthetic fibers or threads)
  2. Manual Techniques
    1. Use magnification (e.g. loupes) if available
    2. Attempt to find a free end and unwind the hair or thread with fine forceps
    3. Cutting ligature
      1. Attempt to lift ligature off skin with forceps without teeth (or Mosquito clamp)
      2. Cut ligature with iris scissors or hooked scalpel (blade facing away from skin)
  3. Surgery Consultation Indications
    1. Epithelialization
    2. Persistent tissue ischemia
    3. Deep Skin Erosion
  • Complications
  • Missed Hair Tourniquet
  1. Epithelialization over the Hair Tourniquet (embedded foreign body)
  2. Open wound
  3. Cellulitis
  4. Bony Erosions
  • Prevention
  1. Inspect digits and genitalia at bathtime for Hair Tourniquets
  2. Maternal hair care (e.g. brushing) in an area away from the infant
  3. Turn fuzzy clothes inside out in the laundry to reduce loose thread or hair accumulation
  • References
  1. Pensa and Merrit (2023) EM:Rap 23(3): 16-7
  2. Bean (2015) J Pediatr Surg 50(9):1583-5 +PMID: 25783322 [PubMed]
  3. O'Gorman (2011) Pediatr Emerg Care 27(3):203-4 [PubMed]