Diagnosis: Hair tourniquet
Upon close inspection, we discovered hair thread tourniquets constricting the fourth and fifth toes on the baby’s left foot.
Hair tourniquet syndrome primarily affects infants in the first few months of life. The average age of occurrence is 4 months, a time when maternal postpartum hair loss (telogen effluvium) is at its maximum.1,2 It is worth noting, however, that this syndrome has also been observed in toddlers and adolescents.3
Toes are most frequently involved, although cases of hair tourniquets affecting the fingers, penis, labia, clitoris and uvula have been reported.2-7 Infants may be brought to the office or ED with irritability or crying, or with an erythematous extremity.
Why tourniquets are overlooked
Infantile tourniquets may be overlooked because of the fine nature of human hair, the swelling of the involved appendage (which can hide the tourniquet itself), and the presence of baby booties, footed pajamas, and mittens that may obscure injured digits from view.
These tourniquets can cause significant morbidity if they are not quickly identified and removed. The tensile strength of human hair is quite strong, allowing for strangulation and even amputation of appendages. The repetitive motion of hands and feet inside booties or mittens allows constriction to increase.
As this tightening occurs, the tourniquet may cause constrictive lymphatic obstruction, edema of the involved soft tissues, and secondary vascular obstruction of venous outflow and arterial perfusion.5,8,9 Tourniquets can also cut through skin, injuring deeper tissues.
In most instances, the damaged tissue will rapidly reperfuse once the offending tourniquet is unraveled or removed. However, some cases may result in epithelialization over the tourniquet, ischemia, necrosis, and gangrene leading to amputation. Quick recognition of the condition and immediate removal of the constricting tourniquet are key to saving the injured appendage.