An 11-year-old girl child presented at our hospital complaining of a mass in the right labium minora. The patient had experienced a vulvar mass and pain for 3 days and had visited a local gynecologic clinic. At the local clinic, the doctor diagnosed a vulvar mass with severe pain, and referred the patient to our hospital for treatment. The patient had no history of trauma. Examination revealed a half-amputated swollen left labium minora (Fig. 1). The lesion was tender, erythematous, and indurated. A strand of hair was found to be wrapped around the labium minora, thereby inducing accidental strangulation (Fig. 2). The patient's hymen was normal, without irregularity or scarring, and no further lesions were detected. The hair tourniquet was removed immediately using fine-toothed forceps and a Metzenbaum scissor. The patient's pain disappeared immediately.

Hair-thread tourniquet syndrome is a condition that induces ischemic strangulation of appendages by a hair thread. Several organs may be damaged by strangulation via a hair thread or strings of hair, causing ischemia and necrosis. A hair thread may wrap around appendages such as fingers, toes, the penis, clitoris, and labium and strangulate these appendages in infants and children [1,2,5,6]. The condition may cause pain, edema, and ischemic necrosis, and may at worst lead to amputation [1,3,4]. Therefore, this condition requires prompt recognition and treatment to ensure viability of the affected appendages.

Hair tourniquet syndrome is uncommon in general, but this syndrome has been described in detail in the literature, including sporadic case reports [1-4,7,8]. Guillimeau first described tissue strangulation by a thread of hair in 1612, and the first documented report on hair tourniquet syndrome was published in the Lancet in 1832 [5,6]. In 1988, Barton et al. [9] described 66 cases of hair-thread tourniquet syndrome in children between the ages of 8 and 11 years. Most cases of hair tourniquet syndrome occur in young children, with finger wrapping seen most commonly at 4 days to 19 months of age [9]. Penile tourniquet syndrome has been described at an age range of 4 months to 6 years [9]. Labial and clitoral wrapping have been described in older children with an age range of 7 to 11 years [1,3,10,11]. Several reports of labium minora tourniquet syndrome have been published [12,13]. We have described 1 such case here.

Constrictive lymphatic obstruction is the mechanism underlying hair tourniquet syndrome. A thread of human hair is extremely thin, and is, therefore, easily knotted, thereby causing strangulation of affected appendages. Initially, soft tissue edema occurs, followed by the development of secondary obstruction of venous outflow and arterial perfusion, which may finally result in ischemic necrosis and autoamputation.

Diagnosis of this syndrome is always based on clinical findings. To protect affected appendages, prompt recognition and removal of the wrapped hair is very important. Therefore, physicians must be aware of the signs and symptoms of hair tourniquet syndrome, especially of the labia minora. The differential diagnosis of labial hair tourniquet syndrome includes inflammation, allergy, trauma, and sexual abuse [3]. Because labial tourniquet syndrome can result from child abuse, this association should always be excluded first [1,2,4]. Thus, a careful history is required to ensure accurate diagnosis.

As soon as the diagnosis of labial tourniquet syndrome has been established, the hair or the strings of hair must be removed. Removal of the hair thread is possible using fine-toothed forceps and microscissors. Additional antibiotic treatment is required if necrosis or infection of the affected appendages is evident. Further, O'Gorman and Ratnapalan [14] reported the treatment of hair tourniquet syndrome using a depilatory cream in cases in which unwinding of the hair is difficult. Neglect of this condition may lead to dire consequences, including autoamputation of vital body appendages.