Hair-thread strangulation syndrome in childhood: a systematic review


Daniela Djokic a, Gregorio P. Milanibc, Sebastiano A. G. Lavade, Gianluca Gualcoaf, Teresa Coriglianoaf, Mario G. Bianchettiaf, Camilla Lavagnog

Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

Heart Failure and Transplantation, Department of Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom

Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

Pediatric Emergency Department, University Children’s Hospital Zurich, Zurich, Switzerland


INTRODUCTION: Hair-thread strangulation syndrome describes the constriction of a body part by a tightly wound hair or thread. This research aims to review the literature about this entity.

METHODS: A systematic review was performed to characterise hair-thread strangulation syndrome in subjects aged ≤16 years. This pre-registered review (PROSPERO ID: CRD42022363996) followed the PRISMA methodology.

RESULTS: Subjects with digital strangulation were significantly younger (median = 4.0 [interquartile range: 2.0–6.1] months; n = 143) than females with genital strangulation (9.0 [6.8–11] years; n = 36), males with genital strangulation (5.1 [1.9–8.0] years; n = 36), and subjects with non-digital and non-genital strangulation (24 [13–48] months; n = 11). Digital strangulation was followed by an amputation in five (3.5%) and a reconstructive surgical intervention in seven (4.9%) cases. Sequelae occurred in four (11%) cases after female genital strangulation: clitoris autoamputation (n = 2) and surgical removal of a necrotic labium minus (n = 2). Severe complications were observed in 14 (39%) cases with male genital strangulation: urethral fistula (n = 7), urethral transection (n = 2), and partial penile autoamputation (n = 5). A partial uvular autoamputation was observed in one case (9.0%) with non-digital and non-genital strangulation.

CONCLUSIONS: Early recognition and management are crucial to avoid sequelae or long-term care in hair-thread strangulation syndrome.


Hair-thread strangulation syndrome describes the acute constriction of a body part, such as digits or external genitalia, by a tightly wound hair or thread in a young infant, a child, or an adolescent [1]. Narrow constriction reduces lymphatic and venous drainage, resulting in pain, swelling, oedema, and, if recognised late, ischemia [1]. This condition was first observed in the 19th century in a 4-week-old English boy with a painful penis swelling induced by a circumferential hair proximal to the swelling [2].

Hair-thread strangulation syndrome is either not mentioned or only briefly discussed in currently available paediatric textbooks. Its symptoms and presentation may be misdiagnosed, leading to delayed treatment and potentially adverse outcomes. A comprehensive literature review on this condition could help raise awareness among healthcare providers, ultimately improving diagnostic accuracy and patient outcomes. Therefore, we conducted a systematic review on this paediatric syndrome.


Search strategy

This literature review did not require Institutional Review Board approval. It was pre-registered at the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42022363996) and followed the 2020 edition [3] of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) according to the Joanna-Briggs Manual. The search was undertaken in the National Library of Medicine, Excerpta Medica, and Web of Science databases without restriction. The search strategy combined the following terms: “hair strangulation syndrome” OR “hair tourniquet syndrome” OR “hair-thread strangulation syndrome” OR “hair-thread tourniquet syndrome” OR “strangulation syndrome” OR “tourniquet syndrome”.

Articles available in Google Scholar or already known to the authors were also considered.The search was undertaken in February 2022 and repeated before submission (November 2022).

Following a first round of selection based on title and abstract, the full text of the selected articles was evaluated for eligibility.

Eligibility criteria and data extraction

Eligible articles were original reports and letters published in peer-review journals describing individual subjects aged ≤16 years with hair-thread strangulation affecting the digits, the external female genitalia, the penis, or other appendages. Cases with rubber band syndrome around the wrist were excluded [4]. Cases published only as abstracts and case series not detailing information on individual cases were also excluded.

The extracted data included demographics, the anatomic location, the source of strangulation (hair, threads, or elastic bands), the possible deliberate strangulation (by a caregiver or self-inflicted), the necessity of a reconstructive surgical procedure, and the outcome (development of long-term sequelae).

Two investigators independently (and in duplicate) performed the literature search, the selection of reports retained for analysis, and the data extraction in an unblinded manner with the support of a senior investigator. Any disagreements were discussed. One investigator entered the data into a pilot-tested database, and another verified them for accuracy.


Pairwise deletion was used for missing data. Discrete variables are presented as counts and compared using Fisher’s exact test. Numerical variables are presented as medians and interquartile ranges or as box-and-whisker plots and compared using Kruskal–Wallis and Tukey’s tests [5, 6]. Two-sided P-values of <0.05 were considered statistically significant. Data were analysed using GraphPad Prism (version 9.5.1).


Search output

The literature search identified 231 potentially relevant articles (figure 1). After removing irrelevant articles, 168 full-text articles were reviewed for eligibility. One hundred fifty-two articles [2, 7–157] describing individual cases of hair-thread strangulation syndrome published between 1951 and 2022 in English (n = 147), German (n = 2), French (n = 1), Spanish (n = 1), and Dutch (n = 1) were retained for the final analysis.

Figure 1Digital, female genital, male genital, and non-digital non-genital hair-thread strangulation syndrome in childhood. PRISMA flowchart of the literature search.

Fifty-eight articles reported cases from America, 45 from Asia, 39 from Europe, six from Oceania, and four from Africa. The articles provided information on 226 cases: 143 cases of digital strangulation [2, 7–90], 36 of female genital strangulation [22, 36, 49, 86, 91–119], 36 of male genital strangulation [7, 12, 24, 120–147], and 11 cases of non-digital and non-genital strangulation [148–157]. Characteristics of the individual cases are provided in the supplementary material (supplementary tables 1–4).

Clinical data

General data

Subjects with digital hair-thread strangulation syndrome (females: 50%; males: 50%) were significantly (p < 0.01) younger (4.0 [2.0–6.1] months) than females with genital strangulation (9.0 [6.8–11] years), males with genital strangulation (5.1 [1.9–8.0] years), and subjects (females: 58%; males: 42%) with non-digital and non-genital strangulation (24 [13–48] months; figure 2). Females with genital strangulation, males with genital strangulation, and subjects with non-digital and non-genital strangulation did not differ significantly in age.

Figure 2Age at presentation in paediatric patients with the various forms of hair-thread strangulation syndrome. The results are presented as box and whisker plots. Please note that the vertical axis is on a logarithmic scale. The age at presentation was significantly lower in children with digital strangulation than in children with strangulation of genitalia (p <0.005) or other appendages (p <0.01).

Twenty-nine (13%) of the 226 cases were explicitly reported as not induced by hairs but by threads arising from footed pyjamas, mittens, socks, underwear, and a nylon or elastic band. Three (1.3%) further cases were caused by hairs and threads.

The prevalence of cases not associated only with hairs was significantly higher (p = 0.0003) for digital strangulation (n = 29; 20%) than for the other forms of strangulation syndrome (n = 3; 3.6%).

A non-accidental cause of strangulation was suspected in 21 cases [12, 17, 36, 132, 133, 143]. Voluntary penile constriction was induced to manage enuresis in three cases [132, 133, 143].

Digital strangulation syndrome

Patients with digital hair-thread strangulation syndrome presented with irritability, crying, digital swelling, discolouration, and pain. About four fifths of the 143 cases of digital strangulation syndrome were observed on the toes (table 1). The female-to-male ratio did not differ significantly (p = 0.336) between infants with toe compared to finger strangulation syndrome. Cases with toe strangulation were slightly but significantly older than those with finger strangulation by 1.5 months on average (p = 0.034).

Table 1Fingers and toes with hair-thread strangulation syndrome in 136 paediatric cases.

Total Right Left
Female:male ratio 0.6*
Age 2.4** [2.0–3.1] months
n 21 10 11
Thumb 7 3 4
Forefinger 3 1 2
Middle finger 6 4 2
Ring finger 5 2 3
Little finger 0 0 0
One finger 21 10 11
Two fingers 0 0 0
Three fingers 0 0 0
Female:male ratio 1.1
Age 4.0 [2.6–5.0] months
n 115 67 48
Big toe 3 2 1
Long toe 28 19 9
Middle toe 82 46 36
Ring toe 45 24 21
Little toe 8 5 3
One toe 79 47 32
Two toes 21 11 10
Three toes 15 9 6
*p = 0.343 and **p = 0.034 versus toe strangulation.

A detailed description of the affected digits was available for 136 (95%) of the 143 cases. Finger strangulation always affected only one finger. In contrast, toe strangulation affected at least two toes in about a third of cases. The little finger, the big toe, and the little toe were relatively rarely affected. Digital strangulation was induced by threads in eight (38%) of 21 cases with finger strangulation and in 12 (10%) of 115 cases with toe strangulation (p = 0.0037).

An amputation was performed in five (3.5%) cases: left thumb (n = 1), left middle toe (n = 1), right big toe (n = 1), right middle toe (n = 1), and right little toe (n = 1) [12, 26, 30, 53, 88]. A reconstructive surgical intervention was necessary in seven (4.9%) cases [12, 28, 29, 41, 70, 74, 81]. Removal of hair thread either mechanically or by applying a depilatory agent was followed by a full recovery in the remaining 131 (92%) cases.

Female genital strangulation syndrome

Hair-thread strangulation syndrome of the female external genital was reported in 36 cases, who presented with genital pain (sometimes associated with wide-base gait or painful micturition), vulvar swelling, or both genital pain and vulvar swelling. The strangulation was localised as follows (two structures were concurrently affected in two cases): clitoris (n = 19), labium minus (n = 16; bilateral in one case), labium majus (n = 2), and mons pubis (n = 1).

Sequelae were observed in four (11%) cases: total clitoris autoamputation in a 14-year-old adolescent, partial clitoris autoamputation in a 5-year-old girl, and surgical removal of a necrotic labium minus in a 6-year-old and a 10-year-old girl [95, 97, 105, 119].The remaining 32 cases recovered uneventfully.

Male genital strangulation syndrome

Hair-thread strangulation syndrome of the male external genital was reported in 36 cases. Young infants presented with irritability and crying, often associated with swelling; older children presented with pain and swelling.

Severe complications were observed in 14 (39%) cases [121, 123, 127, 128, 130, 134–136, 141, 143, 145–147]: urethral fistula (n = 7), urethral transection (n = 2), and partial penile autoamputation (n = 5).

Non-digital and non-genital strangulation syndrome

A non-digital and non-genital strangulation syndrome was noted in 11 cases (female-to-male ratio = 1.3): uvula (n = 5), neck (n = 3), circumvallate tongue papilla (n = 2), and tooth (n = 1). A partial uvular autoamputation was observed in one case [157].


This literature review addressed the entire spectrum of conditions that may be caused by hair-thread strangulation in paediatric patients. While it found that they mainly affected the digits of young infants, they could also occur in older children. It also demonstrated that severe sequelae or the need for long-term care are possible (especially in cases with digital or penile strangulation). Furthermore, strangulation is sometimes non-accidental (e.g. intentional application to manage bedwetting). Finally, some cases were not caused by hairs but by threads or an elastic band.

Infants with hair strangulation often presented with a history of acute excessive crying [158, 159]. While the cause of acute and unexplained infantile crying is often benign, a careful history and physical examination remain the cornerstone of the evaluation. However, many cases present with local symptoms and signs such as pain, swelling, or discolouration. Detecting the encircling hair (which might be more challenging with light-coloured hairs) or thread is critical for diagnosis.

Because of the risk of ischemic damage, rapid management of hair-thread strangulation syndrome is crucial [160, 161]. Our review did not specifically address this issue. After taking a history and performing an examination to make the diagnosis, the first management step is currently appropriate analgesia [162]. Chemical depilatory agents, which break hairs (or threads) and subsequently lead to a weakening of the fibres and eventual dissolution, are currently the first-line treatment choice because they are generally painless and noninvasive [160, 161]. Mechanical release should be performed if strangulation release is not achieved after two attempts with a depilatory agent. Cases with strangulation near mucous membranes or with signs of ischemia should be treated with primary mechanical release [160, 161].

In infants, strangulation was caused mainly by maternal hair related to increased hair loss after birth [163]. It is assumed that hair may fall unnoticed into the bath water during routine care or diaper changing.

Our review had both weaknesses and strengths. Its main weakness was the low number of identified cases. The second weakness was its inability to address potential risk factors, such as socioeconomic status or ethnicity. Its most relevant strength was that it covered the entire spectrum of conditions that may be caused by hair-thread strangulation in paediatric patients. For example, two recent reviews focused explicitly on the hair-thread strangulation syndrome of the female genital tract or both the female and the male genital tracts [118, 164].


Early recognition and management are crucial to avoid sequelae or long-term care in hair-thread strangulation syndrome. Children and infants with unexpected acute onset of crying or local symptoms and signs such as pain, swelling, or discolouration require rapid medical evaluation. Healthcare professionals should be aware of this condition, with a particular focus on digital strangulation in infants and genital strangulation in children.

Data sharing statement

The data underlying this article can be shared upon reasonable request to the corresponding author.


Dr. Lava is the current recipient of research grants from Fonds de perfectionnement, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Fondation SICPA, Prilly, Switzerland; Fondazione Dr. Ettore Balli, Bellinzona, Switzerland, Fondazione per il bambino malato della Svizzera italiana, Bellinzona, Switzerland and Frieda Locher-Hofmann Stiftung, Zürich, Switzerland.

Author contributions: Drs. Milani, Bianchetti and Lavagno conceptualized and designed the review. Drs. Djokic, Milani, Lava and Lavagno acquired the data and performed the analysis. Drs. Djokic, Bianchetti and Lavagno drafted the initial manuscript. All authors reviewed and revised the manuscript and approved the final manuscript as submitted.


Financial disclosure

This research received no external funding.

Potential competing interests

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflict of interest related to the content of this manuscript was disclosed.

Dr. Gregorio P Milani

Fondazione IRCCS Ca’ Granda

Ospedale Maggiore Policlinico

IT-20122 Milan



1. Barton DJ, Sloan GM, Nichter LS, Reinisch JF. Hair-thread tourniquet syndrome. Pediatrics. 1988 Dec;82(6):925–8. 10.1542/peds.82.6.925

2. Ligature of the penis. Lancet. 1832;18(453):136. 10.1016/S0140-6736(02)82355-8

3. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021 Jun;134:178–89. 10.1016/j.jclinepi.2021.03.001

4. Meier R, Haug L, Surke C, Mathys L, Vögelin E. Acquired constriction ring: a case of rubber band syndrome. Pediatr Emerg Care. 2019 Jun;35(6):e113–5. 10.1097/PEC.0000000000000992

5. Bahna SL, McLarty JW. Data presentation. Ann Allergy Asthma Immunol. 2009 Oct;103(4 Suppl 1):S15–21. 10.1016/s1081-1206(10)60816-2 10.1016/S1081-1206(10)60816-2

6. Gaddis GM, Gaddis ML. Introduction to biostatistics: Part 5, Statistical inference techniques for hypothesis testing with nonparametric data [Erratum in: Ann Emerg Med 1991;20(5]. Ann Emerg Med. 1990 Sep;19(9):1054–9. 10.1016/s0196-0644(05)82571-5 10.1016/S0196-0644(05)82571-5

7. Alpert JJ, Filler R, Glaser HH. Strangulation of an appendage by hair wrapping. N Engl J Med. 1965 Oct;273(16):866–7. 10.1056/NEJM196510142731608

8. Curran JP. Digital strangulation by hair wrapping. J Pediatr. 1966 Jul;69(1):137–8. 10.1016/s0022-3476(66)80374-8 10.1016/S0022-3476(66)80374-8

9. Chown B. Digital strangulation by hair wrapping. Can Med Assoc J. 1967 Dec;97(25):1548. 

10. Hill RH, James ES. Digital strangulation by hair wrapping. Can Med Assoc J. 1967 Nov;97(21):1293. 

11. Hack M, Brish M. A “finger equivalent” of the “toe tourniquet syndrome”. Pediatrics. 1972 Aug;50(2):348–9. 10.1542/peds.50.2.348

12. Kerry RL, Chapman DD. Strangulation of appendages by hair and thread. J Pediatr Surg. 1973 Feb;8(1):23–7. 10.1016/0022-3468(73)90289-3

13. Mack JW, Takamoto RM, Jones FR, Zick HR. Toe tourniquet syndrome. West J Med. 1976 Oct;125(4):335–6. 

14. Douglas DD. Dissolving hair wrapped around an infant’s digit. J Pediatr. 1977 Jul;91(1):162. 10.1016/s0022-3476(77)80478-2 10.1016/S0022-3476(77)80478-2

15. Miller PR, Levi JH. Hair strangulation. J Bone Joint Surg Am. 1977 Jan;59(1):132. 10.2106/00004623-197759010-00028

16. Arato A, Szamosfalvi I. Strangulation of toe caused by mother’s hair. Lancet. 1978 Jun;1(8076):1257–8. 10.1016/s0140-6736(78)92488-1 10.1016/S0140-6736(78)92488-1

17. Narkewicz RM. Distal digital occlusion. Pediatrics. 1978 Jun;61(6):922–3. 10.1542/peds.61.6.922

18. Mosely LH. Digital entanglement in the blanket string: case of the necrosing digit. N Z Med J. 1979 Aug;90(642):150–2. 

19. Bérard J. Les cheveux étrangleurs ou toes tourniquet syndrome [Strangler hair or the toe tourniquet syndrome]. Pediatrie. 1981;36(7):539–42. 

20. Manfredi SJ. Accidental appendage strangulation. Plast Reconstr Surg. 1981 Jan;67(1):60–2. 10.1097/00006534-198101000-00014

21. Collins AG. Hair-Thread Tourniquet syndrome. Australas J Dermatol. 1990;31(2):117–8. 10.1111/j.1440-0960.1990.tb00669.x

22. Beasley SW. Strangulation of the clitoris by cotton fluff — another variant of hair-thread tourniquet syndrome. Pediatr Surg Int. 1991;6(4-5):383. 10.1007/BF00178666

23. Liow RY, Budny P, Regan PJ. Hair thread tourniquet syndrome. J Accid Emerg Med. 1996 Mar;13(2):138–9. 10.1136/emj.13.2.138

24. Vázquez Rueda F, Núñez Núñez R, Gómez Meleno P, Blesa Sánchez E. Sińdrome del torniquete por cabellos o hilos en dedos y pene [The hair-thread tourniquet syndrome of the toes and penis]. An Esp Pediatr. 1996 Jan;44(1):17–20. 

25. Conners G. Index of suspicion. Case 2. Hair tourniquet syndrome. Pediatr Rev. 1997 Aug;18(8):283–5. 10.1542/pir.18-8-283

26. Leferink VJ, Klaase JM. Het teentourniquetsyndroom [Toe tourniquet syndrome]. Ned Tijdschr Geneeskd. 1997 Dec;141(51):2499–501. 

27. Debo HF, Kostelanetz A, Morrison G, Brown EG. Red, edematous toes in two infants. J Pediatr Health Care. 1999;13(6 Pt 1):303. 10.1016/s0891-5245(99)90025-1 10.1016/S0891-5245(99)90025-1

28. Sudhan ST, Gupta S, Plutarco C. Toe-tourniquet syndrome—accidental or intentional? Eur J Pediatr. 2000 Nov;159(11):866. 10.1007/pl00008357 10.1007/PL00008357

29. Sunil TM. The Hair-Thread-Tourniquet Syndrome - report of an unusual presentation of this rare condition. Hand Surg. 2001 Dec;6(2):231–3. 10.1142/s0218810401000746 10.1142/S0218810401000746

30. Wang M, Schott J, Tunnessen WW Jr. Picture of the month. Hair-thread tourniquet syndrome. Arch Pediatr Adolesc Med. 2001 Apr;155(4):515–6. 10.1001/archpedi.155.4.515

31. Corazza M, Carlà E, Altieri E, Virgili A. What syndrome is this? Tourniquet syndrome. Pediatr Dermatol. 2002;19(6):555–6. 10.1046/j.1525-1470.2002.00233.x

32. Harris EJ. Acute digital ischemia in infants: the hair-thread tourniquet syndrome—a report of two cases. J Foot Ankle Surg. 2002;41(2):112–6. 10.1016/s1067-2516(02)80035-7 10.1016/S1067-2516(02)80035-7

33. Smith AM, Peckett W, Davies M. Acquired constriction ring syndrome. Foot Ankle Int. 2003 Aug;24(8):640–1. 10.1177/107110070302400812

34. Strahlman RS. Toe tourniquet syndrome in association with maternal hair loss. Pediatrics. 2003 Mar;111(3):685–7. 10.1542/peds.111.3.685

35. Karalezli K, Karakoç Y, Iltar S, Karalezli N, Irgit K. Hair-thread tourniquet syndrome. A case report. Acta Orthop Belg. 2004 Apr;70(2):180–1. 

36. Klusmann A, Lenard HG. Tourniquet syndrome—accident or abuse? Eur J Pediatr. 2004 Aug;163(8):495–8. 10.1007/s00431-004-1466-1

37. Mackey S, Hettiaratchy S, Dickinson J. Hair-tourniquet syndrome—multiple toes and bilaterality. Eur J Emerg Med. 2005 Aug;12(4):191–2. 10.1097/00063110-200508000-00009

38. Gutiérrez-Gómez C, Hernández-Antúnez BG. Toes hair thread tourniquet syndrome. Case report. Bol Méd Hosp Infant México. 2006;63(4):268. 

39. Kurup HV, Gnanapavan M, McSweeney L. Hair-tourniquet syndrome: unwind or incise? Emerg Med Australas. 2006 Aug;18(4):415. 10.1111/j.1742-6723.2006.00882.x

40. Lohana P, Vashishta GN, Price N. Toe-tourniquet syndrome: a diagnostic dilemma! Ann R Coll Surg Engl. 2006 Jul;88(4):W6-8. 10.1308/147870806X95276

41. Mat Saad AZ, Purcell EM, McCann JJ. Hair-thread tourniquet syndrome in an infant with bony erosion: a case report, literature review, and meta-analysis. Ann Plast Surg. 2006 Oct;57(4):447–52. 10.1097/

42. O’Quinn JC, Friedman RL, Wilms KL. Acquired constriction ring syndrome. J Am Podiatr Med Assoc. 2006;96(3):253–5. 10.7547/0960253

43. von Känel OE. [Tourniquet syndrome — case report] [Tourniquet syndrome - case report]. Handchir Mikrochir Plast Chir. 2006 Apr;38(2):119–21. 10.1055/s-2006-923783

44. Anwar MU, Ahmad M. The toe tourniquet syndrome. J Coll Physicians Surg Pak. 2007 May;17(5):309–10. 

45. Haene RA, Loeffler M. Hair tourniquet syndrome in an infant. J Bone Joint Surg Br. 2007 Feb;89(2):244–5. 10.1302/0301-620X.89B2.17626

46. Kumaravel S. Chronic nonhealing ulcer in a finger of a toddler—a rare presentation of the hair thread tourniquet syndrome. Int J Dermatol. 2008 Nov;47(11):1174–6. 10.1111/j.1365-4632.2008.03871.x

47. Singh V, Singh P, Sharma A, Sarkar J. Acquired constriction ring syndrome as a cause of inconsolable cry in a child: a case report. Cases J. 2008 Aug;1(1):92. 10.1186/1757-1626-1-92

48. Al-Buainain H, Al-Jehani Y, Al-Ghamdi Z. Hair-thread tourniquet syndrome. Kuwait Med J. 2009;41(3):259–60. 

49. Cutrone M, Magagnato L. Hair thread tourniquet syndrome. Three cases in ten years. Eur J Pediatr Dermatol. 2009;19(1):23–6. 

50. García-Mata S, Hidalgo-Ovejero A. Hair tourniquet syndrome of the toe: report of 2 new cases. J Pediatr Orthop. 2009 Dec;29(8):860–4. 10.1097/BPO.0b013e3181b7ff14

51. Unlü C, Gundlach U, Vrouenraets BC. Toe hair-thread tourniquet syndrome. South Med J. 2009 Jun;102(6):663–4. 10.1097/SMJ.0b013e3181a2e33e

52. Cevik Y, Kavalci C. Hair tourniquet syndrome. Ann Saudi Med. 2010;30(5):416–7. 10.4103/0256-4947.67088

53. Heather J, Bisson M. Constriction “Band-Aid” syndrome causing digital ischaemia. N Z Med J. 2011 Jul;124(1338):107–10. 

54. O’Gorman A, Ratnapalan S. Hair tourniquet management. Pediatr Emerg Care. 2011 Mar;27(3):203–4. 10.1097/PEC.0b013e31820d65b7

55. Onyeama CO, Vitale K, Cochran K, Onyeama GL. Swelling and redness of the fourth toe in a 3-month-old infant [Erratum in: Pediatr Rev. 2011;32(7]. Pediatr Rev. 2011 Jun;32(6):253–5. 10.1542/pir.32-6-253 10.1542/pir.32.6.253

56. Shankar R, Rao PS, Shetty KB, Sahu P, Singal R, Gupta S. Digital strangulation in a child: tourniquet syndrome. Indian J Dermatol Venereol Leprol. 2012;78(3):408. 10.4103/0378-6323.95489

57. Sivathasan N, Vijayarajan L. Hair-thread tourniquet syndrome: a case report and literature review. Case Rep Med. 2012;2012:171368. 10.1155/2012/171368

58. Wan WC, Yau MM, Lau DC, Huen KF, Chan LT. Hair tourniquet syndrome in a young infant. Hong Kong J Paediatr. 2012;17:119–22. 

59. Alvarez-Pérez A, Mateo S, Fernández-Redondo V, Toribio J. Hair-thread tourniquet syndrome: a hidden hazard. Pediatr Dermatol. 2013;30(4):e61–2. 10.1111/j.1525-1470.2012.01820.x

60. Hickey BA, Gulati S, Maripuri SN. Hair toe tourniquet syndrome in a four-year-old boy. J Emerg Med. 2013 Feb;44(2):358–9. 10.1016/j.jemermed.2012.03.004

61. Au S, Landers JT. Hair-thread tourniquet syndrome: a case report and review of treatment. Dermatol Online J. 2014;20(10):13030/qt7w85g4s4. 10.5070/D32010024259

62. Bizzotto N, Sandri A, Regis D, Carpeggiani G, Lavini F, Magnan B. Serious delayed hair toe tourniquet syndrome with bone erosion and flexor tendon lesion. Case Rep Pediatr. 2014;2014:592323. 10.1155/2014/592323

63. Kamal NM, Khan UU, Mirza SJ, Al-Malki TA. Toe tourniquet syndrome. Saudi Med J. 2014 Aug;35(8):865–7. 

64. Alruwaili N, Alshehri HA, Halimeh B. Hair tourniquet syndrome: successful management with a painless technique. Int J Pediatr Adolesc Med. 2015 Mar;2(1):34–7. 10.1016/j.ijpam.2015.02.003

65. Baloch N, Atif M, Rashid RH, Hashmi PM. Toe-tourniquet syndrome: A rare potentially devastating entity. Malays Orthop J. 2015 Nov;9(3):55–7. 10.5704/MOJ.1511.008

66. Baştuğ O, Korkmaz L, Korkut S, Halis H, Kurtoğlu S. Hair-thread tourniquet syndrome in a preterm baby. Turk Pediatri Ars. 2015 Dec;50(4):245–7. 10.5152/TurkPediatriArs.2015.1301

67. El-Kehdy J, Nasr J, Bitar C, El-Habr C, Abi-Rached Megarbane H, Sammour R, et al. Don’t miss this blue toe: hair tourniquet syndrome. J Eur Acad Dermatol Venereol. 2015 Jan;29(1):191–2. 10.1111/jdv.12393

68. Hussin P, Mawardi M, Masran MS, Ganaisan P. Hair tourniquet syndrome: revisited. G Chir. 2015;36(5):219–21. 10.11138/gchir/2015.36.5.219

69. Kuiper JW, de Korte N. Hair thread tourniquet syndrome in a toe of an 18 mo old girl. World J Clin Cases. 2015 Apr;3(4):368–70. 10.12998/wjcc.v3.i4.368

70. Pinkowsky GJ, Hennrikus WL. Toe tourniquet syndrome caused by cable tie. Pediatr Emerg Care. 2015 Jun;31(6):431–2. 10.1097/PEC.0000000000000461

71. Pye S, Banks J, Pal C. Loom bands: a case of post-tourniquet syndrome. Arch Dis Child. 2015 May;100(5):481. 10.1136/archdischild-2014-307438

72. van Meurs A, Korpershoek M, van Herwaarden-Lindenboom M. Female infant with toe swelling. Ann Emerg Med. 2016 Jun;67(6):785–96. 10.1016/j.annemergmed.2015.12.002

73. Dunphy L, Verma Y, Morhij R, Lamyman M. Hair thread tourniquet syndrome in a male infant: a rare surgical emergency. BMJ Case Rep. 2017 Nov;2017:bcr2017221002. 10.1136/bcr-2017-221002

74. Ojha S, Pandey VK, Garg G, Bansal R. “Missed band under the band”: don’t miss it! Indian J Pediatr. 2017 May;84(5):410–1. 10.1007/s12098-016-2275-z

75. Rahul SK, Behera S, Suman P, Mohapatra S. Hair tourniquet syndrome. Med J DY Patil Univ. 2017;10(1):79–81. 10.4103/0975-2870.197919

76. Tengattini V, Magnano M, Patrizi A, Neri I. Sudden swelling and redness of the toe. Clin Case Rep. 2017 Sep;5(11):1901–2. 10.1002/ccr3.1115

77. 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 Mar;26(2):193–4. 10.1097/BPB.0000000000000348

78. Yadav R, Rahul SK, Kumar V, Zaheer H, Thakur K, Agarwal A. Toe tourniquet syndrome. J Indira Gandhi Inst Med Sci. 2017;3(1):34–5. 

79. Booth J, Morse T. Hair toe tourniquets: a review of two case studies. Emerg Nurse. Pediatr Int (Roma). 2018;60(12):1095–6. 10.1111/ped.13712

80. Kesu Belani L, Leong JF, Narin Singh PSG, Abdullah S. Hair thread tourniquet syndrome in an infant: emergency exploration saves limbs. 2018;26(2):31-35. 

81. Sebaratnam DF, Hernández-Martín Á. Utility of ultrasonography in hair-thread tourniquet syndrome. Pediatr Dermatol. 2018 Mar;35(2):e138–9. 10.1111/pde.13400

82. Singh AP, Tanger R, Mathur V, Gupta AK. Hair tourniquet syndrome: A rare case report. Menoufia Med J. 2018;30(4):1260–1. 10.4103/mmj.mmj_111_17

83. Agharbi FZ. Le syndrome des cheveux étrangleurs: à propos d’un cas [Strangler hair syndrome: about a case]. Pan Afr Med J. 2019 Jul;33:266. 10.11604/pamj.2019.33.266.15699

84. Aslantürk O, Özbey R, Yılmaz Ö, Ergen E. Hair tourniquet syndrome of toes and fingers in infants. Acta Orthop Traumatol Turc. 2019 Jul;53(4):306–9. 10.1016/j.aott.2019.04.010

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

86. Ihara T, Takei H, Kishibe S, Nomura O. Hair tourniquet syndrome on the toe and labia. Cureus. 2019;11(12):e6377. 10.7759/cureus.6377

87. Azizalrahman A, Wani SA, Alnasser OM. Irritable infant: a rare and easy to miss case for strangulated toe. Saudi J Emerg Med. 2020;1(2):121–3. 10.24911/SJEMED.72-1573244443 10.24911/SJEMed/72-1573244443

88. McGrath RB, Cahill KC, Eadie PA, Harty SB. Thumb autoamputation following tourniquet syndrome. BMJ Case Rep. 2020 Mar;13(3):e233143. 10.1136/bcr-2019-233143

89. Shafiq MA, Anwar K, Tan JA. The fretful child with swollen appendages: mitten the insidious. Asian J Med Biomed. 2020;4(1):31–3. 10.37231/ajmb.2020.4.1.327

90. Sutcu M, Yildiran G, Akdag O. Hair-thread tourniquet syndrome: two case reports. Turk J Plast Surg. 2020;28:237–9. 0.4103/tjps.tjps_62_19

91. Chapman HL. Digital strangulation by hair wrapping. Can Med Assoc J. 1968 Jan;98(2):125. 

92. Press S, Schachner L, Paul P. Clitoris tourniquet syndrome. Pediatrics. 1980 Nov;66(5):781–2. 10.1542/peds.66.5.781

93. Summers JL, Guira AC. Hair strangulation of the external genitalia: report of two cases. Ohio State Med J. 1973 Sep;69(9):672–3. 

94. Webley JA, Schleif DR, Coleman J. Tourniquet Syndrome: an unusual presentation. Ann Emerg Med. 1981 Sep;10(9):494–5. 10.1016/s0196-0644(81)80288-0 10.1016/S0196-0644(81)80288-0

95. Rich MA, Keating MA. Hair tourniquet syndrome of the clitoris. J Urol. 1999 Jul;162(1):190–1. 10.1097/00005392-199907000-00067

96. Sylwestrzak MS, Fischer BF, Fischer H. Recurrent clitoral tourniquet syndrome. Pediatrics. 2000 Apr;105(4 Pt 1):866–7. 10.1542/peds.105.4.866

97. Kuo JH, Smith LM, Berkowitz CD. A hair tourniquet resulting in strangulation and amputation of the clitoris. Obstet Gynecol. 2002 May;99(5 Pt 2):939–41. 10.1016/s0029-7844(01)01753-7 10.1016/S0029-7844(01)01753-7

98. Serour F, Gorenstein A. Treatment of the toe tourniquet syndrome in infants. Pediatr Surg Int. 2003 Oct;19(8):598–600. 10.1007/s00383-003-1034-1

99. Bacon JL, Burgis JT. Hair thread tourniquet syndrome in adolescents: a presentation and review of the literature. J Pediatr Adolesc Gynecol. 2005 Jun;18(3):155–6. 10.1016/j.jpag.2005.03.010

100. Golshevsky J, Chuen J, Tung PH. Hair-thread tourniquet syndrome. J Paediatr Child Health. 2005 Mar;41(3):154–5. 10.1111/j.1440-1754.2005.00569.x

101. Osterhoudt KC, Beleniski F. Images in emergency medicine. The hair tourniquet syndrome. Ann Emerg Med. 2005 Apr;45(4):458–63. 10.1016/j.annemergmed.2004.08.051

102. Alverson B. A genital hair tourniquet in a 9-year-old girl. Pediatr Emerg Care. 2007 Mar;23(3):169–70. 10.1097/PEC.0b013e3180328cc4

103. Pomeranz M, Schachter B, Capua T, Beyth Y. Hair-thread tourniquet syndrome of labia minor. J Pediatr Adolesc Gynecol. 2009 Oct;22(5):e111–3. 10.1016/j.jpag.2008.07.011

104. Stock C, Wang LC, Spigland NA. Untangling a web: an unusual case of labial necrosis in an adolescent female. J Pediatr Adolesc Gynecol. 2012 Apr;25(2):e21–2. 10.1016/j.jpag.2011.11.001

105. Bannier MA, Miedema CJ. Hair tourniquet syndrome. Eur J Pediatr. 2013 Feb;172(2):277. 10.1007/s00431-012-1883-5

106. Dua A, Jamshidi R, Lal DR. Labial hair tourniquet: unusual complication of an unrepaired genital laceration. Pediatr Emerg Care. 2013 Jul;29(7):829–30. 10.1097/PEC.0b013e3182986184

107. Lee JH, Pringle K, Rajimwale A. Red herring vaginal discharge. BMJ Case Rep. 2013 Sep;2013 sep18 1:bcr2013200367. 10.1136/bcr-2013-200367

108. Ozcakir E, Kaya M. A genital hair tourniquet syndrome: case report and review of the literature. Pediatr Urol Case Rep. 2014;1(2):1–4. 10.14534/PUCR.201424403

109. Panagidis A, Sinopidis X, Alexopoulos V, Georgiou G. Hair tourniquet syndrome of labia minora. APSP J Case Rep. 2015 May;6(2):22. 

110. Parlak M, Karakaya AE. Hair-thread tourniquet syndrome of the hypertrophic clitoris in a 6-year-old girl. Pediatr Emerg Care. 2015 May;31(5):363–4. 10.1097/PEC.0000000000000341

111. Zimmerman LN, Wagner AJ. Clitoral hair tourniquet: a case report and review of the literature. Int J Pediatr Res 2015;1(2):007. 10.23937/2469-5769/1510007

112. Zhong N, Bhattacharyya R. Hair tourniquet of the clitoris: A novel treatment. J Pediatr Surg Case Rep. 2017;27:26–7. 10.1016/j.epsc.2017.09.003

113. Roman E. Adolescent labial hair tourniquet. Aust N Z J Obstet Gynaecol. 2018;58:72. 

114. Erikci VS, Sayan A, Gokhan Koyluoglu G. Hair tourniquet syndrome of the clitoris and labia minora: report of three cases and review of the literature. Pediatr Urol Case Rep. 2019;6(6):127–31. 10.14534/j-pucr.2019655917

115. Imam AS, Florez CE, Beland L, Swana H, Rich M. Hair tourniquet of the labia minora. J Pediatr Surg Case Rep. 2019;44:101160. 10.1016/j.epsc.2019.01.012

116. Diaz-Morales O, Martinez-Pajares JD, Ramos-Diaz JC, Gutierrez Del Alamo Lopez J, Trigo-Moreno J. Genital hair-thread tourniquet syndrome. J Pediatr Adolesc Gynecol. 2020 Dec;33(6):715–9. 10.1016/j.jpag.2020.05.009

117. Minodier P, Cohen-Boulakia R, Aguesse C, Fruscione S, Urbina D. Genital hear tourniquet syndrome in a 5-year old girl. Ann Clin Med Case Reports. 2020;5(5):1–2. 10.47829/ACMCR.2020.5504

118. Adjei N, Lynn A, Dugan K, Vash-Margita A. Medically Indicated Labiaplasty in a Case of Recurrent Labial Hair Thread Tourniquet Syndrome in a Premenarchal Girl. J Pediatr Adolesc Gynecol. 2021 Oct;34(5):761–3. 10.1016/j.jpag.2021.03.007

119. Chawla RK, Lakkunarajah S, Jay MS. Vulvar discomfort in a 10-year-old girl. Pediatr Rev. 2021 Aug;42(8):e33–6. 10.1542/pir.2020-003020

120. DeWEESE JA, Eikner WC. Strangulation of the penis with a human hair. Urol Cutaneous Rev. 1951 Jan;55(1):37–8. 

121. Farah R, Cerny JC. Penis tourniquet syndrome and penile amputation. Urology. 1973 Sep;2(3):310–1. 10.1016/0090-4295(73)90473-1

122. Haddad FS. Penile strangulation by human hair. Report of three cases and review of the literature. Urol Int. 1982;37(6):375–88. 10.1159/000280843

123. McClure WJ, Gradinger GP. Hair strangulation of the glans penis. Plast Reconstr Surg. 1985 Jul;76(1):120–3. 10.1097/00006534-198507000-00022 10.1097/00006534-198507000-00021

124. Sheinfeld J, Cos LR, Erturk E, Cockett AT. Penile tourniquet injury due to a coil of hair. J Urol. 1985 Jun;133(6):1042–3. 10.1016/s0022-5347(17)49371-2 10.1016/S0022-5347(17)49371-2

125. Mariani PJ, Wagner DK. Topical cocaine prior to treatment of penile tourniquet syndrome. J Emerg Med. 1986;4(3):205–7. 10.1016/0736-4679(86)90042-9

126. Pantuck AJ, Kraus SL, Barone JG. Hair strangulation injury of the penis. Pediatr Emerg Care. 1997 Dec;13(6):423–4. 10.1097/00006565-199712000-00020

127. Bangroo AK, Chauhan S. Hair tourniquet syndrome. J Indian Assoc Pediatr Surg. 2005;10(1):55–6. 10.4103/0971-9261.16080

128. Chaware SM, Gajbhiye R, Singh RA. Penile tourniquet injury due to a coil of hair. Indian J Plast Surg. 2006;39(1):70–2. 10.1055/s-0039-1700466 10.4103/0970-0358.26909

129. Dar NR, Siddiqui S, Qayyum R, Ghafoor T. Hair coil strangulation—an uncommon cause of penile edema. Pediatr Dermatol. 2007;24(4):E33–5. 10.1111/j.1525-1470.2007.00436.x

130. Hussain HM. A hair tourniquet resulting in strangulation and amputation of penis: case report and literature review. J Paediatr Child Health. 2008 Oct;44(10):606–7. 10.1111/j.1440-1754.2008.01394.x

131. Okeke LI. Thread embedded into penile tissue over time as an unusual hair thread tourniquet injury to the penis: a case report. J Med Case Rep. 2008 Jul;2(1):230. 10.1186/1752-1947-2-230

132. Basner A, Gumpert S, Lütkenhaus D, Kaatsch HJ, Schwark T. Penishämatom mit Schwellung. Seltener Fall von Kindesmisshandlung? Rechtsmedizin [Penile hematoma with swelling. A rare case of child abuse?]. 2012;22:479–481. 10.1007/s00194-012-0852-7

133. Pahwa HS, Kumar A, Srivastava R, Kumar S, Goel A, Ahmad A. Partial penile amputation due to penile tourniquet syndrome in a child troubled with primary nocturnal enuresis—a rare emergency. Urology. 2013 Mar;81(3):653–4. 10.1016/j.urology.2012.11.012

134. Jesus LE, Bragança JJ, Rocha JM, Dekermacher S, Anderson KM. Penile hair tourniquet resulting in hypospadias failure. Indian J Urol. 2014 Jul;30(3):345–7. 10.4103/0970-1591.128508

135. Dikshit VK, Gupta RK, Kothari PR, Gupta AR, Kamble RS, Kesan KV. Near total penile amputation caused by hair tourniquet, managed with the URAGPI procedure. Afr J Urol. 2015;21(4):254–7. 10.1016/j.afju.2014.11.010

136. Gazali ZA, Singal AK. Hair Thread Tourniquet Syndrome of Penis Causing Urethral Fistula. Indian Pediatr. 2015 Jun;52(6):538. 

137. Zengin K, Ozdamar MY, Albayrak S, Tanik S, Atar M, Bakirtas H, et al. Hair coil penile tourniquet syndrome in an unusual age. Case Rep Urol. 2015;2015:642547. 10.1155/2015/642547

138. Sekhon V, Peters NJ, Mahajan JK. Penile hair tourniquet syndrome: A case report and review of literature. Pediatr Urol Case Rep. 2017;4(3):311–4. 10.14534/PUCR.2017327011

139. Sheikh Andalibi MS, Azarfar A, Esmaeeli M, Sheykh Andalibi N, Alizadeh A, Ravanshad Y. Penile hair tourniquet syndrome due to a coil of hair: first report in Iran. Nephrourol Mon. 2017;9(4):e59788. 10.5812/numonthly.59788

140. Özçift B, Ağras K. Hair tourniquet syndrome of penis: A rare situation in boys with serious complications if not recognized. Turk J Urol. 2018 Aug;45(4):322–4. 10.5152/tud.2018.36699

141. Arshadi H, Fatemi Behbehani SM, Karimi A, Lotfi B. Penile strangulation by hair: a case report. Case Rep Clin Pract. 2019;4(2):44–7. 10.18502/crcp.v4i2.1705

142. Degheili JA, El-Asmar JM, Aoun B. Penile hair strangulation: A prodigious cause of pediatric agitation. Clin Case Rep. 2019 May;7(7):1452–3. 10.1002/ccr3.2198

143. Bouassida K, Ben Ahmed K, Ben Othmen M, Jaidane M. Penile hair coil strangulation in a 9-year-old patient: surgical management and review of the literature. Ann Med Surg (Lond). 2020 Oct;60:50–5. 10.1016/j.amsu.2020.10.020

144. Rawls WF, White JT, Mohamed A, Peppas D, Rosenberg E. Case report: penile strangulation secondary to hair tourniquet. Front Pediatr. 2020 Aug;8:477. 10.3389/fped.2020.00477

145. Patterson JW, Haberman C, Skelton JA, Pranikoff T, Northrop S. Infantile penile degloving injury secondary to hair tourniquet. J Pediatr Surg Case Rep. 2022;80:102250. 10.1016/j.epsc.2022.102250

146. Rampersad B, Dubay C, Doodnath R. Penile hair tourniquet to base of penis resulting in circumferential separation of shaft skin without vascular compromise: an unusual case report. Urol Case Rep. 2022 Feb;42:102030. 10.1016/j.eucr.2022.102030

147. Loloi J, Andreas D, Gitlin J. Severe penile hair tourniquet syndrome with near amputation of the glans. J Clin Urol. 2023 Jan;16(1):51–4. 10.1177/2051415820939465; Epub ahead of print. 

148. McNeal RM, Cruickshank JC. Strangulation of the uvula by hair wrapping. Clin Pediatr (Phila). 1987 Nov;26(11):599–600. 10.1177/000992288702601111

149. Krishna S, Paul RI. Hair tourniquet of the uvula. J Emerg Med. 2003 Apr;24(3):325–6. 10.1016/s0736-4679(02)00760-6 10.1016/S0736-4679(02)00760-6

150. Chegwidden HJ, Poirier MP. Near strangulation as a result of hair tourniquet syndrome. Clin Pediatr (Phila). 2005 May;44(4):359–61. 10.1177/000992280504400413

151. Schneider K, Kennebeck S, Madden L, Campbell A. Hair tourniquet of the circumvallate papillae: a potentially “hairy” situation. Pediatr Emerg Care. 2013 Aug;29(8):924–5. 10.1097/PEC.0b013e31829ec4c7

152. Flores JR. Hair tourniquet syndrome in the dental patient. Anesth Prog. 2014;61(3):111–2. 10.2344/0003-3006-61.3.111

153. Alghamdi F, Alrashed R, Alsadhan N. Tongue papillae thread tourniquet removal under sedation: an apparently challenging case. J Gen Emerg Med. 2018;3(2):039. 

154. Wong K, Tiyyagura G, Langhan ML. Accidental strangulation: a rare but potential risk of co-sleeping. Pediatr Oncall. 2019;16(1):21–2. 10.7199/ped.oncall.2019.2

155. Stansfield J, Coey J, Mirza O, Loughran S. Uvula strangulation: a rare case of hair thread tourniquet syndrome. Int J Surg Case Rep. 2020;2(3):2. 10.31487/j.IJSCR.2020.03.10

156. Chan LY, Chan TW, Tay MK. Accidental hair strangulation of a toddler caught on home surveillance camera. Arch Dis Child. 2021 Nov;106(11):1046. 10.1136/archdischild-2020-320669

157. Leighton J, Powell J, McLarnon C. Hair-thread Tourniquet Syndrome causing uvular strangulation in a child. BMJ Case Rep. 2021 Apr;14(4):e242350. 10.1136/bcr-2021-242350

158. Poole SR. The infant with acute, unexplained, excessive crying. Pediatrics. 1991 Sep;88(3):450–5. 10.1542/peds.88.3.450

159. Freedman SB, Al-Harthy N, Thull-Freedman J. The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics. 2009 Mar;123(3):841–8. 10.1542/peds.2008-0113

160. Gottlieb M, Holladay D, Spearman D. Current approach to the evaluation and management of hair-thread tourniquets. Pediatr Emerg Care. 2019 May;35(5):377–9. 10.1097/PEC.0000000000001827

161. Kudzinskas A, Reed A, Mahdi M, Tyler M. Evaluation of depilatory agents in the treatment of hair-thread tourniquet syndrome. J Emerg Med. 2021 Nov;61(5):507–16. 10.1016/j.jemermed.2021.07.013

162. Bauman BH, McManus JG Jr. Pediatric pain management in the emergency department. Emerg Med Clin North Am. 2005 May;23(2):393–414. 10.1016/j.emc.2004.12.008

163. Eastham JH. Postpartum alopecia. Ann Pharmacother. 2001 Feb;35(2):255–8. 10.1345/aph.10153

164. De Vitis LA, Barba M, Lazzarin S, Molinari S, Spinelli M, Arosio E, et al. Female genital hair-thread tourniquet syndrome: a case report and literature systematic review. J Pediatr Adolesc Gynecol. 2021 Feb;34(1):65–70. 10.1016/j.jpag.2020.07.007

Appendix: Supplementary tables

Supplementary table 1Characteristics of 143 individuals affected by digital hair-thread strangulation syndrome. The country of publication is identified using the International vehicle registration code.

Case First author Year of publication Country Sex Age (months)
1 Alpert JJ [7] 1965 USA Male 2.0
2 Male 19
3 Curran JP [8] 1966 USA Male 2.5
4 Chonwn [9] 1967 CDN 12
5 Hill RH [10] 1967 CDN 5.0
6 Hack M [11] 1972 IL Female 0.8
7 Kerry RL [12] 1973 USA Male 4.0
8 Male 1.8
9 Male 5.0
10 Female 2.3
11 Male 1.5
12 Female 1.8
13 Female 3.5
14 Mack JW [13] 1976 USA Female 11
15 Male 5.0
16 Douglas DD [14] 1977 USA 10
17 Female 11
18 Miller PR [15] 1977 USA Female 15
19 Arato A [16] 1978 H 6.0
20 Narkewicz RM [17] 1978 USA Male 4.0
21 Male 3.0
22 Male 1.0
23 Mosely LH [18] 1979 NZ Female 2.0
24 Bérard J [19] 1981 F Male 6.0
25 Male 3.0
26 Male 3.0
27 Manfemaleredi SJ [20] 1981 USA Female 7.0
28 Male 3.0
29 Barton DJ [1] 1988 USA Male 5.0
30 Female 2.0
31 Female 4.0
32 Male 1.8
33 Male 144
34 Female 0.6
35 Collins AG [21] 1990 AUS Female 14
36 Beasley SW [22] 1993 USA 2.5
37 Liow RY [23] 1996 UK Female 18
38 Male 3.0
39 Vazquez Rueda F [24] 1996 E Female 2.0
40 Male 4.0
41 Male 2.0
42 Female 5.0
43 Male 3.0
44 Male 7.0
45 Conners G [25] 1997 USA Male 5.0
46 Lefemaleerink VJ [26] 1997 NL Male 4.0
47 Male 4.0
48 Female 2.0
49 Male 0.8
50 Debo HF [27] 1999 USA Male 2.0
51 Male 4.0
52 Sudhan ST [28] 2000 UK 5.0
53 Sunil TM [29] 2001 IND Female 8.0
54 Wang M [30] 2001 USA 1.5
55 Corazza M [31] 2002 I Female 72
56 Harris EJ [32] 2002 Female 5.0
57 Male 5.0
58 Smith AM [33] 2003 UK Male 7.0
59 Strahlman RS [34] 2003 USA Male 3.0
60 Karalezli K [35] 2004 B Male 3.0
61 Klusmann A [36] 2004 D 4.0
62 4.0
63 1.5
64 2.0
65 Mackey S [37] 2005 UK Female 3.0
66 Gutiérrez-Gómez C [38] 2006 MEX Female 2.0
67 Kurup HV [39] 2006 UK Male 3.0
68 Lohana P [40] 2006 UK 1.5
69 Mat Saad AZ [41] 2006 IRL Female 3.0
70 O'Quinn JC [42] 2006 USA Female 2.3
71 von Känel OE [43] 2006 CH Male 2.0
72 Anwar MU [44] 2007 UK Female 4.0
73 Haene RA [45] 2007 UK 2.8
74 Kumaravel S [46] 2008 IND 24
75 Singh V [47] 2008 UK Female 14
76 Al-Buainain H [48] 2009 KSA Male 3.0
77 Cutrone M [49] 2009 I Female 2.0
78 Female 2.0
79 Garcia-Mata S [50] 2009 USA Female 18
80 Male 5.0
81 Ünlü C [51] 2009 NL Male 5.0
82 Cevik Y [52] 2010 TR Female 4.0
83 Heather J [53] 2011 NZ Female 36
84 O'Gorman A [54] 2011 USA Male 3.0
85 Onyeama CO [55] 2011 USA Male 3.0
86 Sivathasan N [57] 2012 UK
88 Shankar R [56] 2012 IND Female 1.0
89 Wan WCY [58] 2012 CHN Female 2.0
90 Alvarez-Perez A [59] 2013 E Male 8.0
91 Hickey BA [60] 2013 UK Male 48
92 Au S [61] 2014 USA Male 6.0
93 Bizzotto N [62] 2014 I Female 2.0
94 Kamal NM [63] 2014 KSA Female 6.0
95 Male 6.0
98 Baloch N [65] 2015 PK Female 4.0
99 Bastug O [66] 2015 TR Female 0.5
100 El-Kehdy J [67] 2015 RL Female 6.0
102 Hussin P [68] 2015 MAL Female 3.0
103 Male 5.0
104 Kuiper JW [69] 2015 NL Female 18
105 Pinkowsky GJ [70] 2015 USA Female 84
106 Pye S [71] 2015 UK Female 48
Alruwaili N [64] 2016 KSA Male 6.0
107 van Meurs A [72] 2016 USA Female 4.0
108 Dunphy L [73] 2017 UK Male 2.0
109 Ojha S [74] 2017 IND Female 12
110 Rahul SK [75] 2017 IND Male 3.0
111 Tengattini V [76] 2017 I Female 8.0
112 Uygur E [77] 2017 TR Female 4.0
113 Female 6.0
114 Yadav R [78] 2017 IND Male 2.0
115 Booth J [79] 2018 UK Male 3.0
116 14
117 Ihara T [86] 2018 J Female 1.3
118 Sebaratnam D [81] 2018 E Female 24
119 Singh AP [82] 2018 IND Male 1.5
120 Agherbi F [83] 2019 MA
121 Aslantürk O [84] 2019 TR Male 2.0
122 Male 5.6
123 Female 1.9
124 Female 3.5
125 Female 0.6
126 Male 4.3
127 Male 2.0
128 Female 4.0
129 Male 1.0
130 Male 13
131 Male 0.8
132 Male 3.9
133 Female 6.0
134 Female 2.8
135 Female 2.6
136 Female 9.1
137 Basheer SM [85] 2019 BRN Female 5.0
138 Kesu Belani L [80] 2019 MAL Female 2.0
139 Azizalrahman A [87] 2020 KSA Female 3.0
140 McGrath RB [88] 2020 IRL Male 12
141 Shafemaleiq MA [89] 2020 MAL 2.0
142 Sutcu M [90] 2020 TR Female 2.0
143 Male 0.5

Supplementary table 2Characteristics of 36 female subjects affected by genital hair-thread strangulation syndrome. The country of publication is identified using the International vehicle registration code.

Case First author Year of publication Country Age (years)
1 Chapman HL [91] 1968 CDN 9
2 Summers JL [93] 1973 USA 11
3 Webley JA [94] 1973 USA 7
4 Press S [92] 1980 USA 8
5 Beasley S.W [22] 1991 AUS 8
6 Rich MA [95] 1999 USA 5
7 Sylvestzrak MS [96] 2000 USA 5
8 Kuo JH [97] 2001 USA 14
9 Golshevsky J [100] 2004 AUS 14
10 Klusmann A [36] 2004 D 12
11 Bacon JL [99] 2005 USA 13
12 Osterhoudt KC [101] 2005 USA 8
13 Alverson B [102] 2007 USA 9
14 Serour F [98] 2007 IL 4
15 Cutrone M [49] 2009 I 0.5
16 Pomeranz M [103] 2009 IL 11
17 Stock C [104] 2012 USA 12
18 Bannier MA [105] 2013 NL 6
19 Dua A [106] 2013 USA 12
20 Lee JH [107] 2013 UK 11
22 Ozcakir E [108] 2014 TR 9
22 Panagidis A [109] 2015 GR 14
23 10
24 Parlak M [110] 2015 TR 6
25 Zimmerman LN [111] 2015 USA 5
26 Zhong N [112] 2017 USA 10
27 Ihara T [86] 2018 J 14
28 Roman E [113] 2018 AUS 12
29 Erikci VS [114] 2019 TR 8
30 7
31 9
32 Imam AS [115] 2019 USA 6
33 Diaz-Morales O [116] 2020 E 10
34 Minodier P [117] 2020 F 5
35 Chawla RK [119] 2021 USA 10
36 Adjei N [118] 2021 USA 11

Supplementary table 3Characteristics of 36 male subjects affected by genital hair-thread strangulation syndrome. The country of publication is identified using the International vehicle registration code.

Case First author Year of publication Country Age (months)
1 DeWeese JA [120] 1952 USA 22
2 Alpert JJ [7] 1965 USA 13
3 Farah R [121] 1973 USA 132
4 Kerry RL [12] 1973 USA 2
5 4
6 10
7 Haddad FS [122] 1982 USA 24
8 24
9 McClure WJ [123] 1985 USA 60
10 Sheinfeld J [124] 1985 USA 84
11 Mariani PJ [125] 1986 USA 60
12 Vazquez Rueda F [24] 1996 E 24
13 48
14 Pantuck AJ [126] 1997 USA 36
15 Bangroo AK [127] 2005 IND 120
16 Chaware SM [128] 2006 IND 84
17 Dar NR [129] 2007 PK 60
18 Hussain HM [130] 2008 AUS 72
19 Okeke LI [131] 2008 NGR 108
20 Basner A [132] 2012 D 2
21 Pahwa HS [133] 2013 IND 96
22 Jesus LE [134] 2014 BR 120
23 Dikshit VK [135] 2015 IND 120
24 Gazali ZA [136] 2015 IND 72
25 Zengin K [137] 2015 TR 96
26 Sekhon V [138] 2017 IND 84
27 Sheikh Andalibi MS [139] 2017 IR 54
28 Arshadi H [141] 2019 IR 108
29 Degheili JA [142] 2019 RL 48
30 Ozcift B [140] 2019 TR 48
31 Bouassida K [143] 2020 TN 108
32 Rawls WF [144] 2020 PK 24
33 17
34 Loloi J [147] 2021 USA 96
35 Patterson JW [145] 2022 USA 0.5
36 Rampersad B [146] 2022 TT 24

Supplementary table 4Characteristics of 11 individuals affected by non-digital and non-genital hair-thread strangulation syndrome. The country of publication is identified using the International vehicle registration code.

Case First author Year of publication Country Sex Age (months)
1 McNeal RM [148] 1987 USA Male 13
2 Krishna S [149] 2003 USA 3
3 Chegwidden HJ [150] 2005 USA Female 11
4 Schneider K [151] 2013 USA Female 84
5 Flores JR [152] 2014 MEX 24
6 48
7 Alghamdi F [153] 2018 KSA Female 48
8 Wong K [154] 2019 USA Male 13
9 Chan LYF [156] 2020 HK Male 21
10 Stansfield J [155] 2020 UK 9
11 Leighton J [157] 2021 UK Female 36