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