Hair Tourniquet Syndrome

What is Hair Tourniquet Syndrome?

Like all new parents, I find myself continually rifling through a repetitive mental checklist every time I hear the new addition to the family start to cry. Is she too hot? Is she too cold? When did she last eat (she can’t possibly be hungry already!)? Does she need to be changed? Does her head feel warm? (Here honey, feel her forehead…now feel my head…now feel yours…do they feel the same?) This scenario seems to play out 20 times a day in newborn baby households around the world. Could it be hair tourniquet syndrome?

Given my unique line of work as a foot and ankle surgeon, I do have one other checkbox that I constantly review; that is, could this particular screaming fit be the result of hair tourniquet syndrome? Many new, and even experienced, parents have never even heard of hair tourniquet syndrome. While rare, hair tourniquet syndrome can have devastating results.  This should be something added to the new parents checklist when their little one starts to fuss.

With hair tourniquet syndrome, hair, thread, or similar thin pliable material becomes so tightly wrapped around an appendage that pain, laceration of tissue, and in extreme cases, loss of affected appendage can occur.  Forty percent of reported hair tourniquet syndrome cases involve the toes.  Babies under 4 months old represent the highest risk age group.  This is because 90% of new moms experience some degree of post-partum hair loss immediately following childbirth. New moms spend so much time in close contact with baby during feedings, diaper changes, and washing, as well as folding an endless amount of tiny person laundry that loose strands of hair can easily become lost inside the baby’s socks and footed clothing. The constant wiggling and kicking motion that new babies do cause the loose hair or thread to become spontaneously tied around the toe.  It will continue to constrict the area if not immediately addressed.

Implications

Once the hair or thread has wrapped itself around the toe, the material then acts as a tourniquet.  This tourniquet will begin to block adequate blood supply to the toe.  It will also block appropriate blood return out of the toe.  This reaction causes the toe to become swollen and turn color to bright red, blue, and purple. As the swelling increases, the hair remains tightly constricted and can lacerate the tissue similar to cutting cheese with a cheese-wire. Extended periods of time with inadequate oxygen flow to the affected toe can lead to ischemia and gangrene.  In turn, this can ultimately lead to amputation of the toe due to significant tissue death. Fortunately, amputation of the digit is extremely rare.

Signs

Early signs of hair tourniquet syndrome can often be missed as most of the time  a newborn is in socks or closed-toe clothing.  The onset of symptoms may not be obvious. However, early signs to look for include a sudden onset of an inconsolable baby.  Remove clothing covering the toes as inspect each one.  Parents should look for red, swollen toes, where hair stands may be evident, making the cause of distress much more obvious.

Treatment

Initial treatment includes unwinding hair under magnification with fine surgical instruments. If laceration of soft tissue has already occurred, or should hair not become untwined, then surgical removal may be necessary. Surgery includes making a small incision through hair and baby’s toe to release foreign material. Surgery is done under anesthesia in the operating room and while the incision causes injury to the baby, it usually prevents loss of the toe. Regardless of the effective treatment method, this condition is an emergent situation and early action is imperative to prevent tissue death.

Prevention includes checking baby’s socks and clothes for loose hair or thread prior to dressing.  Washing baby’s clothing inside out may also prevent wayward hairs.

Hair tourniquet syndrome is, fortunately, a rare phenomenon but should be added to every parent’s “crying baby” checklist. The good news is, while a very distressing situation to endure as a parent, outcomes remain consistently excellent.