Hair-Thread Tourniquet Syndrome: a Presentation of an Infant

Case Report Archives of Case Reports in Clinical Medicine Open Access

Hair-Thread Tourniquet Syndrome: A Presentation of an Infant

Ugur LOK, Umut Gulacti*, Tayfun Borta, Murat Celik, Nurettin Aktas, and Hasan Buyukaslan Adiyaman University of Medical Faculty, Department of Emergency Medicine, Adiyaman, Turkey

Received Date: July 29, 2016, Accepted Date: September 08, 2016, Published Date: September 16, 2016. *Corresponding author: Umut Gulacti, Adiyaman University of Medical Faculty, Department of Emergency Medicine, Adiyaman, Turkey, Tel: +90-535- 585- 1900; Fax: +90-416-227-0863; E-mail: [email protected]

Introduction Hair toe tourniquet syndrome (HTS) is an emergency constrictive injury. It is commonly diagnosed in children under one year of age, but infants under six months are particularly at risk, in which a hair or thread encircles a digit and results in acute digital necrosis. The syndrome is characterized by the presence of a hair are the most commonly affected parts with this entity. When the toescoiled are tightly involved, around the the encircling fingers, itemtoes oris mostgenitals. likely Fingers a human and hair.toes Prompt diagnosis and rapid removal of the constricting material is crucial, and can save the digit from irreversible tissue damage and the loss of the digit. Awareness of HTS is essential for early diagnosis and prompt treatment to protect against the development of serious complications to the toe and other body parts [1-7]. We present here clinicopathologic aspects of a case of possible recurrent encirclement of a toe by a hair coil. Case A 3-month old male infant was referred to Adiyaman University research and education hospital emergency department (ED) by his mother with complaints of unrelieved crying episodes, swelling and redness on the left 5th toe for 4 hours duration. The same event emerged a few days earlier on the opposite foot but resolved spontaneously, mother reported. Past medical history revealed that he was born to a 19 year old primigravida via normal spontaneous vaginal birth in 2014. She noted that there was no history of baby sitter, recent trauma or injury, but he was wearing footed pajamas or footgear regularly. On physical examination he appeared clinically irritable, and had no fever and discharge but there was gross swelling of the left 5th toe, with purple discoloration. Capillary Figure 1: discoloration and circumferential tissue cleft (black arrow) caused by two seconds) was four seconds, and digital pain sensation was hair coil following Figures removal show of gross hair coil. swelling of 5th toe with purple increased.refill time, There which were is an not indicator nail abnormalities of perfusion or status skin lacerations (normal is a hair coil was removed easily by a clamp and scissors from the ants are clinically irritable which provides digitdetected in ED. (Figure After a1). period A diagnosis of observation of hair entrapment the baby’s crying was made episodes and resolved and the patient was discharged from ED with outpatient Most of the inf follow up by the orthopedic surgeon. symptomsthe impetus to forthe presentationdiagnosis. The and hair search may be for so a deeply specific embedded etiology. Most parents give a history of a 3 to 4 day delay from the onset of Discussion that it can escape easy recognition [4]. Although the majority of HTS seems to be accidental in nature, presenting with redness and swelling of the affected toe. Various In the literature, this syndrome was first described in 1971, have indicated that more than 50% of children with typical cases are thread Tourniquet Syndrome, hair tourniquet syndrome, hair coil abuse.professionals A prompt, from attentive the fields and of medicine,subtle investigation nursing and for child some welfare other strangulationnames are used syndrome, for definition toe tourniquet of this condition syndrome, such tourniquet as Hair- signs of abuse in the patient should be made before establishing a syndrome, or acquired constriction ring syndrome. The average judgment related to the probability of abuse [1]. HTS is unusual and age of presentation is six months, the peak incidence emerges in newborns, infants and young children, and however, they may be the injury can result in ischemia and amputation of the limb [2]. also noted in adolescents. The etiology consists of various causes Coilingthe consequences material leadscan be to catastrophic. an obstruction Failure to tovenous timely returnrecognize or such as sociocultural practices, nonaccidental injuries, maternal same rare psychiatric disorders and child or elderly abuse (1,2,7-9). candirectly result arterial in tissue blood ischemia flow from an thed potential digit, followed loss of by the swelling digit and[7]. telogen effluvium, Munchausen’s syndrome, learning disabilities, reduction of the arterial inflow. Delay in diagnose of this condition

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Prompt recognition of cases by emergency doctors, healthcare keep in mind that hair thread tourniquet syndrome is unusual but workers, general practitioners or other health care professionals is the consequences can be severe. important to prevent function loss or toe amputation [2,9]. Conflict of Interest Differential diagnosis of HTS includes Streeter’s dysplasia, infection, contact dermatitis, allergic reaction, insect bites, foreign bodies, ainhum, pseudoainhum, paronychia, and child abuse. Paronychia is a fairly common occurrence in this age group, and encirclement over the ReferencesNo conflict of interest was declared by the authors. 1. Claudet I, Pasian N, Debuisson C, Salanne S, Rekhroukh H. Tourniquet Treatment begins with the recognition of the condition and syndrome: interest of a systematic analysis of families’ social conditions distal phalanx could cause difficulty in diagnosis [4]. to detect neglect situations. Child Abuse Negl. 2009;33(9):569–72. doi: 10.1016/j.chiabu.2009.03.003. step in management. If complete removal of the constructing materialremoval ofis achieved constricting in the material ED and urgently provides that normal is the perfusion critical first to 2. Srinivasaiah N, Yalamuri RR, Vetrivel S, Irwin L. Limb tourniquet syndrome - A cautionary tale. Injury Extra. 2008;39(4):140–2. recommend surgical decompression with the infant under general 3. Peckler B, Hsu CK. Tourniquet syndrome: a review of constricting band anesthesiathe toe, surgical in order exploration to permit mayfurther be exploration, avoided. Most retrieval authorities of all of the foreign matter, and release of any constricting bands in the 4. Harris EJ. Acute digital ischemia in infants: the hair-thread tourniquet operating room. The use of depilatory agents to dissolve the hair removal. J Emerg Med. 2001;20(3):253–62. has been recommended by some authors [4,7]. 5. syndrome--aBacon JL, Burgis report JT. ofHair two thread cases. Jtourniquet Foot Ankle syndromeSurg. 2002;41(2):112–6. in adolescents: Once the part has been decompressed, ultraconservative a presentation and review of the literature. J Pediatr Adolesc Gynecol. management is indicated in order to give the best chance for 2005;18(3):155–6. survival. Adequate time for recovery should be allowed before 6. Badawy H, Soliman A, Ouf A, Hammad A, Orabi S, Hanno A. Progressive hair making the decision to debride or amputate. Prophylactic coil penile tourniquet syndrome: multicenter experience with 25 cases. J antibiotics directed at Staphylococcus aureus should be considered Pediatr Surg. 2010;45(7):1514-8. doi: 10.1016/j.jpedsurg.2009.11.008. [4]. The prognosis for survival may actually be very good in spite of the initial presentation. 7. jemermed.2012.03.004Hickey BA, Gulati S, Maripuri SN. Hair toe tourniquet syndrome in a Conclusion four-year-old boy. J Emerg Med. 2013;44(2):358–9. doi: 10.1016/j. 8. Strahlman RS. Toe tourniquet syndrome in association with maternal Infants are more susceptible to digital ischemia if a toe is hair loss. Pediatrics. 2003;111(3):685–7. encircled by a strand of hair or some other similar material. An early diagnosis and prompt removal of material is important in 9. order to prevent loss of the part. The emergency doctors should syndrome. Pediatr Dermatol. 2002;19(6):555–6. Corazza M, Carlà E, Altieri E, Virgili A. What syndrome is this? Tourniquet

*Corresponding author: [email protected] Umut Gulacti, Adiyaman University of Medical Faculty, Department of Emergency Medicine, Adiyaman, Turkey, Tel: +90-535- Received585-1900; Date: Fax: +90-416-227-0863; July 29, 2016, Accepted E-mail: Date: September 08, 2016, Published Date: September 16, 2016. Copyright: © 2016 Ugur LOK, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Ugur LOK, Gulacti U, Borta T, Celik , Aktas N, Buyukaslan H (2016) Hair-Thread Tourniquet Syndrome: A Presentation of an Infant. Arc Cas 124. M Rep CMed 2(3):

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Citation: Ugur LOK, Gulacti U, Borta T, Celik M, Aktas N, Buyukaslan H (2016) Hair-Thread Tourniquet Syndrome: A Presen- Page 2 of 2 tation of an Infant. Arc Cas Rep CMed 2(3): 124.