Tourniquet syndrome in children (literature review and own observation)


  • V.S. Konoplitskyi National Pirogov Memorial Medical University, Vinnytsya, Ukraine
  • S.V. Chornyi СEI «Vinnytsia Regional Children’s Clinical Hospital of Vinnytsia Regional Council», Ukraine
  • Yu.Ye. Korobko National Pirogov Memorial Medical University, Vinnytsya, Ukraine
  • B.L. Pavlenko National Pirogov Memorial Medical University, Vinnytsya, Ukraine
  • S.M. Sytnyk СEI «Vinnytsia Regional Children’s Clinical Hospital of Vinnytsia Regional Council», Ukraine
  • N.S. Nesterov СEI «Vinnytsia Regional Children’s Clinical Hospital of Vinnytsia Regional Council», Ukraine
  • V.M. Kravchuk СEI «Vinnytsia Regional Children’s Clinical Hospital of Vinnytsia Regional Council», Ukraine



tourniquet syndrome, hair bundle syndrome, ischemia, necrosis, strangulation, children, foot, finger


Tourniquet syndrome is a complex of pathological changes that occur in response to strangulation circular compression of part/parts of the body or organ, characterized by neurovascular disorders that can lead to the development of necrosis and gangrene. Strangulation of soft tissues can occur with various fibrous materials - wool, cotton, various cords, jewelry, Christmas tree decorations. In children, the most common cause of strangulation is hair and threads, in adults - jewelry.

Purpose - to draw the attention of the medical community to a rare pathology, the tourniquet syndrome in children, which, despite its rather characteristic picture, is not always immediately recognized, which can lead to serious consequences.

The leading etiological factor in the development of tourniquet syndrome can be postpartum telogen outflow in mothers, which is manifested by a large amount of hair prone to loss. The authors recognize the toes as the most frequent localization of the strangulation hair bundle in tourniquet syndrome, the II and III toes of the feet and hands are more often caught in the loop. Also, it is not uncommon for several fingers to be entwined. With tourniquet syndrome, a complication in the form of necrosis of the fingers, which requires their amputation, is about 7% of all cases of finger and foot pathology. Quick recognition and removal of the tourniquet for genitaltourniquet syndromeprevents devascularization of the clitoris and penis and their possible self-amputation.

Conclusions. Hair bundle syndrome, or tourniquet syndrome, most often occurs in young children and can have serious consequences. To prevent this phenomenon, children’s clothes should be checked for the presence of threads and loops on the inside, the presence of piles of hair and threads in the “blind” parts of the clothes, turn the clothes inside out before washing, which helps prevent the accumulation of future bundles. It is also recommended that mother and child sleep separately. In case of injuries of the upper limbs, it is recommended to know jewelry from the fingers. Alertness about tourniquet syndrome will help avoid serious complications in children. It should also be remembered about the intentional cruel treatment of children with the imposition of potential bounties.

No conflict of interests was declared by the authors.


Alpert JJ, Filler R, Glaser HH. (1965). Strangulation of an appendage by hair wrapping. New England Journal of Medicine. 273 (16): 866-867.; PMid:5825906

Alruwaili N, Alshehri HA, Halimeh B. (2015). Hair tourniquet syndrome: Successful management with a painless technique. International Journal of Pediatrics and Adolescent Medicine. 2 (1): 34-37.; PMid:30805434 PMCid:PMC6372396

Amir S, Ahmad M, Sadiq M. (2013). Hair tourniquet syndrome. Journal of Postgraduate Medical Institute. 27 (3).

Aslantürk O, Özbey R, Yılmaz Ö, Ergen E. (2019). Hair tourniquet syndrome of toes and fingers in infants. Acta orthopaedica et traumatologica turcica. 53 (4): 306-309.; PMid:31104884 PMCid:PMC6738272

Barton DJ, Sloan GM, Nichter LS, Reinisch JF. (1988). Hair-thread tourniquet syndrome. Pediatrics. 82 (6): 925-928.

Basheer SM, Gerashi AR, Basith MA. (2019). Hair torniquet syndrome, an unusual presentation: a case report and review of literature. Int J Case Rep Images. 10: 100992Z01BS2019.

Baştuğ O, Korkmaz L, Korkut S, Halis H, Kurtoğlu S. (2015). Hair-thread tourniquet syndrome in a preterm baby. Turkish Archives of Pediatrics/Türk Pediatri Arşivi. 50 (4): 245.; PMid:26884695 PMCid:PMC4743868

Bean JF, Hebal F, Hunter CJ. (2015). A single center retrospective review of hair tourniquet syndrome and a proposed treatment algorithm. Journal of pediatric surgery. 50 (9): 1583-1585.; PMid:25783322

Biehler JL, Sieck C, Bonner B, Steumky JH. (1994). A survey of health care and child protective services provider knowledge regarding the toe tourniquet syndrome. Child abuse & neglect. 18 (11): 987-993.; PMid:7850607

Cevik Y, Kavalci C. (2010). Hair tourniquet syndrome. Annals of Saudi medicine. 30 (5): 416-417.; PMid:20697160 PMCid:PMC2941260

DeWeese JA, Eikner WC. (1951). Strangulation of the penis with a human hair. Urologic and cutaneous review. 55 (1): 37-38.

Dikshit VK, Gupta RK, Kothari PR, Gupta AR, Kamble RS, Kesan KV. (2015). Near total penile amputation caused by hair tourniquet, managed with the URAGPI procedure. African Journal of Urology. 21 (4): 254-257.

Douglas DD. (1977). Dissolving hair wrapped around an infant's digit. The Journal of pediatrics. 91(1): 162.; PMid:874655

El Mouloua A, Kamili EE, Fouraiji K, Saiad MO. (2022). Hair tourniquet syndrome of labia minora: case report. The Pan African Medical Journal: 43.

Erikci VS, Altundağ T, Köylüoğlu G. (2017). Genital hair tourniquet syndrome: A case report and review of the literature. Trauma Emerg Care. 2: 1.

Farah R, Cerny JC. (1973). Penis tourniquet syndrome and penile amputation. Urology. 2 (3): 310-311.; PMid:4747672

Fasano JrFJ, Hansen RH. (1987). Foreign body granuloma and synovitis of the finger: a hazard of ring removal by the sawing technique. The Journal of hand surgery. 12 (4): 621-623.; PMid:3301999

Fitz-Henley M. (2001). Images and diagnoses. Glanuloma annulare. The West Indian medical journal. 50 (3): 222-248.

Ganakos JJ, Cocores JA, Terris A. (1986). Ainhum (dactylolisis spontanea): Report of bilateral cases and literature review. J. Am. Pod. Med. Assoc. 76: 676-680.; PMid:3806378

Gottlieb M, Holladay D, Spearman D. (2019). Current approach to the evaluation and management of hair-thread tourniquets. Pediatric Emergency Care. 35 (5): 377-379.; PMid:31045982

Haddad FS. (1982). Penile strangulation by human hair. Urologia internationalis. 37 (6): 375-388.; PMid:7179601

Haene RA, Loeffler M. (2007). Hair tourniquet syndrome in an infant. The Journal of Bone and Joint Surgery. British volume. 89 (2): 244-245.; PMid:17322445

Hussein AM. (1993). Chemotherapy-induced alopecia: new developments. Southern medical journal. 86 (5): 489-496.; PMid:8488392

Klusmann A, Lenard HG. (2004). Tourniquet syndrome - accident or abuse? European journal of pediatrics. 163: 495-498.; PMid:15179509

Krishna S, Paul RI. (2003). Hair tourniquet of the uvula. Journal of Emergency Medicine. 24 (3): 325-326.; PMid:12676306

Kumar D, Schaeffer A, Thieu T, Zuckerman A. (2017). Hair Tourniquet Leading to Clitoral Swelling in a 5 Year Old Girl. Journal of Pediatric and Adolescent Gynecology. 30 (2): 290-291.

Kuo JH, Smith LM, Berkowitz CD. (2002). A hair tourniquet resulting in strangulation and amputation of the clitoris. Obstetrics & Gynecology. 99 (5): 939-941.; PMid:11975967

Lee DH, Koh MW. (2012). Hair tourniquet syndrome of the labium minora in an 11-year-old girl: A case report. Korean Journal of Obstetrics & Gynecology. 55 (3): 206-208.

Leighton J, Powell J, McLarnon C. (2021). Hair-thread Tourniquet Syndrome causing uvular strangulation in a child. BMJ case reports. 14 (4): bcr-2021.; PMid:33853822 PMCid:PMC8054077

Mack JW, Takamoto RM, Jones FR, Zick HR. (1976). Toe tourniquet syndrome. Western Journal of Medicine. 125 (4): 335.

Mann TP. (1961). Finger-tip necrosis in the newly born: a hazard of wearing mittens. British Medical Journal. 2 (5269): 1755.; PMid:20789308 PMCid:PMC1970904

McClure WJ, Gradinger GP. (1985). Hair strangulation of the glans penis. Plastic and reconstructive surgery. 76 (1): 120-123.; PMid:4011764

Mhiri MN, Midassi H, Mezghanni M, Smida ML. (1987). Strangulation of glans penis by hair or «penis tourniquet syndrome». Pediatrie. 42 (5): 351-353.

Moran JM. (1964). An unusual foreign body. JAMA. 189 (6): 511-512.; PMid:14162147

Mosely LH. (1979). Digital entanglement in the blanket string: case of the necrosing digit. The New Zealand Medical Journal. 90 (642): 150-152.

Mullett ST. (1995). Ring removal from the oedematous finger. An alternative method. Journal of hand surgery (Edinburgh, Scotland). 20 (4): 496.

Narkewicz RM. (1978). Distal digital occlusion. Pediatrics. 61 (6): 922-923.; PMid:673559

Özçift B, Ağras K. (2019). Hair tourniquet syndrome of penis: A rare situation in boys with serious complications if not recognized. Turkish Journal of Urology. 45 (4): 322.; PMid:31291190 PMCid:PMC6619851

Peckler B, Hsu CK. (2001). Tourniquet syndrome: a review of constricting band removal. The Journal of emergency medicine. 20 (3): 253-262.; PMid:11267813

Pomeranz M, Schachter B, Capua T, Beyth Y. (2009). Hair-thread tourniquet syndrome of labia minor. Journal of Pediatric and Adolescent Gynecology. 22 (5): e111-e113.; PMid:19576823

Press S, Schachner L, Paul P. (1980). Clitoris tourniquet syndrome. Pediatrics. 66 (5): 781-782.; PMid:7432884

Raque CJ, Stein KM, Lane JM, Reese EC. (1972). Pseudoainhum constricting bands of the extremities. Archives of Dermatology. 105 (3): 434-438.; PMid:4334964

Rawls WF, White JT, Mohamed A, Peppas D, Rosenberg E. (2020). Case report: penile strangulation secondary to hair tourniquet. Frontiers in Pediatrics. 8: 477.; PMid:32974247 PMCid:PMC7472550

Rich MA, Keating MA. (1999). Hair tourniquet syndrome of the clitoris. The Journal of urology. 162 (1): 190-191.; PMid:10379786

Riter S, Wills L. (2004). Sleep wars: research and opinion. Pediatric Clinics. 51 (1): 1-13.; PMid:15008579

Ruszkiewicz AR, Lee KA, Landgren AJ. (1994). Homicidal strangulation by victim's own hair presenting as natural death. The American journal of forensic medicine and pathology. 15 (4): 340-343.; PMid:7879779

Sahn DJ. (1971). Penis tourniquet syndrome. Pediatrics. 48 (4): 675-675.; PMid:5114761

Serour F, Gorenstein A. (2003). Treatment of the toe tourniquet syndrome in infants. Pediatric surgery international. 19: 598-600.; PMid:14551712

Strahlman RS. (2003). Toe tourniquet syndrome in association with maternal hair loss. Pediatrics. 111 (3): 685-687.; PMid:12612260

Sudhan ST, Gupta S, Plutarco C. (2000). Toe-tourniquet syndrome-accidental or intentional? European journal of pediatrics. 159 (11): 866.; PMid:11079205

Summers JL, Guira AC. (1973). Hair strangulation of the external genitalia: report of two cases. The Ohio State medical journal. 69 (9): 672-673.

Sunil TM. (2001). The hair-thread-tourniquet syndrome - report of an unusual presentation of this rare condition. Hand Surgery. 6 (2): 231-233.; PMid:11901472

Thilagarajah M. (1999). An improved method of ring removal. Journal of Hand Surgery. 24 (1): 118-119.; PMid:10190622

Thomas Jr AJ, Timmons JW, Perlmutter AD. (1977). Progressive penile amputation: tourniquet injury secondary to hair. Urology. 9 (1): 42-44.; PMid:831352

Zimmerman LN, Wagner AJ. (2015). Clitoral Hair Tourniquet: A Case Report and Review of the Literature. Int J Pediatr Res. 1 (007).