Poster Presentation NZ Association of Plastic Surgeons & NZ Society for Surgery of the Hand

Paediatric digital hair tourniquet: An update on management (1445)

Sam Hamilton 1 , Geoffrey Lee 1 , Nelson Low 1
  1. Plastic and Reconstructive Surgery , Monash Health, Melbourne, VIC, Australia


Hair tourniquet syndrome describes the plastic surgical emergency in which hair or thread wraps around an appendage, forming a tourniquet. (1) This occurs most frequently in infants aged two to six months and may affect any appendage including digits. (2-4) We describe a single department’s experience and a review of the literature.  



We present a case series with clinical images managed successfully with forceps and scissors alone in the emergency department within a two-week period.


A comprehensive search of PubMed was completed, with nine articles meeting inclusion criteria reviewed in full.



Twenty-nine cases were described in the literature, with varying approaches to management. (1, 5-8) Digital salvage required surgical release in each case. Surgical release was performed in theatre or the emergency department. Methods used included stab incision with an 11 blade on the lateral border of the digit, (5) dorsal longitudinal incisions down to the bone, (2) and unwinding the hair with forceps and scissors. (7)


Non-surgical management options include the use of depilatory cream, which acts to break the disulphide bonds of hair. (1) This method is contraindicated if the tourniquet is not hair, close to mucous membranes, the epidermis is breached, or ischaemia is present. (1, 3)


The use of ultrasonography is also described as a convenient adjunct for the diagnosis and confirmation of removal of hair tourniquet by Sebaratnam et al. (8)


Theoretical prevention measures have also been suggested by several publications (2-4, 9).



Digital hair tourniquet should be treated be an experienced surgical team using the methods they feel comfortable with. The author’s preference is to attempt removal with forceps and scissors and then progress to longitudinal incision down to bone if required.




  1. Aslantürk O, Özbey R, Yılmaz Ö, Ergen E. Hair tourniquet syndrome of toes and fingers in infants. Acta Orthop Traumatol Turc. 2019;53(4):306-9.
  2. Booth J, Morse T. Hair toe tourniquets: a review of two case studies. Emerg Nurse. 2018;26(2):31-5.
  3. Gottlieb M, Holladay D, Spearman D. Current Approach to the Evaluation and Management of Hair-Thread Tourniquets. Pediatr Emerg Care. 2019;35(5):377-9.
  4. Templet TA, Rholdon RD. Assessment, Treatment, and Prevention Strategies for Hair-Thread Tourniquet Syndrome in Infants. Nurs Womens Health. 2016;20(4):421-5.
  5. Al Omran Y, Yang D, Ghassemi N, Nassimazdeh M, Huq S. Hair tourniquet syndrome: use the 11-blade before the 11th hour. Br J Hosp Med (Lond). 2019;80(5):296.
  6. Dunphy L, Verma Y, Morhij R, Lamyman M. Hair thread tourniquet syndrome in a male infant: a rare surgical emergency. BMJ Case Rep. 2017;2017.
  7. Ihara T, Takei H, Kishibe S, Nomura O. Hair tourniquet syndrome on the toe and labia. Pediatr Int. 2018;60(12):1095-6.
  8. Sebaratnam DF, Hernández-Martín Á. Utility of ultrasonography in hair-thread tourniquet syndrome. Pediatr Dermatol. 2018;35(2):e138-e9.
  9. Uygur E, Çarkçi E, Ünkar E. Can washing socks without flipping inside out cause hair tourniquet syndrome? A claim with two case reports. J Pediatr Orthop B. 2017;26(2):193-4