Chapter 122: Hair Tourniquet Management

INTRODUCTION

Hair tourniquet syndrome or hair-thread tourniquet syndrome refers to the circumferential constriction of a finger, a toe, or the genitalia by hair or cloth fibers (Figure 122-1). Contraction of the tourniquet can lead to pain, tissue injury, and tissue necrosis if untreated. Infants and young children under 2 years of age are predominantly affected.^1-3 Genital hair tourniquets that affect the clitoris or labia are not as common and tend to occur in older children.^3-5 Hair tourniquets can rarely affect oral structures.^6-8

There can be various clinical presentations. Fussiness and parental perception of pain are the common presenting signs. Always consider a hair tourniquet in the differential for an inconsolable infant. The tourniquet may often be missed during a routine examination as the constriction may be mistaken for a physiologic anatomic crease on the infant’s digit. Risk factors include increased maternal shedding of hair postpartum (e.g., one cause of telogen effluvium), co-bathing of the mother and infant, and co-laundering of clothes of others with those of the infant.^9,10

Prompt diagnosis allows for treatment and prevention of further pain and morbidity. Mechanical release has been the mainstay of tourniquet release. Recent studies have proposed chemical depilatory agents as the primary modality to release a hair tourniquet.⁴

ANATOMY AND PHYSIOLOGY

The hair fiber is an elastic structure that can stretch when dry to 20% to 30% of its original length.¹¹ It can stretch up to 50% of its original length when the hair fiber becomes wet.¹¹ A single strand of hair can be almost transparent, especially when wet.¹² The presumed process of the hair tourniquet syndrome begins when moist or wet hair becomes entrapped within the confines of the infant’s mitten or socks. Repetitive movement of the infant’s flexed digit and contraction of the hair as it dries lead to constriction of the affected digit. The hair may cut into and become embedded within the epidermis. There may be reepithelialization of skin over the embedded hair.

Restriction of lymphatic drainage leads to local tissue edema distal to the constriction. Compromise of the vascular supply can lead to ischemia and necrosis. Erosion of the underlying bone with tendon involvement has been demonstrated in several cases.^9,13 The urethra can be involved with a penile tourniquet.¹⁴

A knowledge of the neurovascular supply of the affected appendage will avoid injury in the mechanical release of a hair tourniquet with an incision. Each finger and toe has four neurovascular bundles with each consisting of a digital artery and nerve. One bundle is located on each of the medial and lateral sides of the ventral and dorsal ...