This POTD is inspired by a case I saw from the periphery while in the Peds ED. I'll be discussing hair tourniquets!
Toe-tourniquet syndrome, also called Hair-thread tourniquet syndrome (HTTS), is a rare and commonly misdiagnosed condition caused by hair or fiber wrapped around digits (fingers and toes), penis, or even clitoris. It usually affects infant and children. Prompt diagnosis is needed as ischemia can result.
This is a diagnosis often missed because the presentation is so vague. Often the only complaint is a crying and inconsolable infant. This is why the physical exam is so important! Redness and swelling distal to a constricting band is usually found, so check all of those digits and do a thorough genital exam.
Treatment includes early recognition of the condition and immediate release of constriction to prevent devastating complication in the form of digit loss or genital damage. Careful circumferential examination of affected part should be done as swelling and erythema, can mimic infection, so correlate clinically with the history. A hand held magnifying glass can be useful in circumstances where the diagnosis is not certain.
Simple removal with scissors or even an IV catheter needle could do the trick. If the skin is intact, hair removal agents, such as Nair, can be used. Apply the agent on the area for about 8 minutes and then rub the agent and hair off. If all else has failed, consider a dorsal slit for cases where skin is broken and tourniquet is too tight for other methods.
With successful removal of the hair tourniquet, patients are discharged home with appropriate follow up.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393137/
https://www.annemergmed.com/article/S0196-0644(15)01574-7/fulltext
https://wikem.org/wiki/Hair_tourniquets#cite_ref-1