Extreme cases may require surgery
Surgical consultation may be required in extreme cases of edema, neurovascular compromise, necrosis, amputation, or failure to completely remove the tourniquet.2
Other factors to keep in mind. While classically described as consisting of a single hair, tourniquets may be comprised of multiple hairs. That’s why it’s important to carefully inspect the area to be sure that all strands have been removed. Thorough treatment should include consideration of child abuse, tetanus immunization, and the need for antibiotics1,2,11 (SOR: B).
Relief for our young patient
To remove our patient’s hair tourniquets, we carefully cut the fibers with hooked Littauer suture-removal scissors and unwrapped the hair. Damage to the plantar aspect of both toes was significant enough that we had to cut through the soft tissue and into the flexor tendon to completely remove the hair. No sutures were required as the wound edges were well approximated without closure.
We cleaned and dressed the injured toes and arranged for close follow-up. The patient’s recovery was uneventful.
To avoid hair tourniquet syndrome, counsel parents to turn mittens and booties inside out to check for loose hairs. Also, advise parents to make sure there aren’t any hairs wrapped around their baby’s fingers or toes. Vigilance on the part of health care providers can provide quick recognition and appropriate treatment of this condition.
CORRESPONDENCE
Tania D. Strout, PhD, RN, MS, Director of Research, Department of Emergency Medicine, Maine Medical Center, 47 Bramhall Street, Portland, ME 04102; Strout@mmc.org