Female Genital Hair-Thread Tourniquet Syndrome: A Case Report and Literature Systematic Review

Delayed Diagnosis of Labial Hair Thread Tourniquet Syndrome in a Postmenarchal Adolescent: A Case Report

BACKGROUND

Hair thread tourniquet syndrome occurs when tissue is strangulated by a hair thread. It occurs most commonly in the digits of infants and young children, but can also occur in the genitalia.

CASE REPORT

A 13-year-old postmenarchal girl with several days of severe vulvar pain and swelling presented to the emergency department. Diagnosis was unclear and she was referred to pediatric and adolescent gynecology. Pelvic examination under anesthesia revealed a hair thread tourniquet involving the bilateral labia minora. The hair tourniquet and portions of bilateral labia minora were excised. Why Should an Emergency Physician Be Aware of This? Genital hair thread tourniquet syndrome is uncommon but must be considered in patients with severe genital pain and swelling. Prompt diagnosis and treatment are important to prevent tissue necrosis and may be facilitated by means of a pelvic examination with sedation.

Hair-thread strangulation syndrome in childhood: a systematic review

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.

Pelvic organ prolapse and vaginal cancer: a systematic literature review

BACKGROUND

Primary vaginal cancer is a rare gynecologic malignancy. Few cases about the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment.

OBJECTIVES

To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions.

SEARCH STRATEGY

We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, Cochrane using a combination of keywords and text words represented by a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse" and "vaginal cancer", "vaginal carcinoma" SELECTION CRITERIA: No article type restrictions were applied.

DATA COLLECTION AND ANALYSIS

Twenty-one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients MAIN RESULTS: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. The surgical approach was the treatment of choice in most cases. On the contrary, exclusive interstitial brachytherapy was rarely performed.

CONCLUSIONS

A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases.

Medically Indicated Labiaplasty in a Case of Recurrent Labial Hair Thread Tourniquet Syndrome in a Premenarchal Girl

BACKGROUND

Despite controversy surrounding labiaplasty in adolescent girls, labiaplasty might be indicated in the case of recurrent labial hair thread tourniquet syndrome (HTTS).

CASE

We describe a case of an 11-year-old girl with recurrent labial HTTS who underwent labiaplasty.

SUMMARY AND CONCLUSION

Recurrent labial HTTS can lead to disfigurement and partial loss of labium. Labiaplasty can restore normal anatomy of the labia and prevent further recurrence in select cases.

Evaluation of Depilatory Agents in the Treatment of Hair-Thread Tourniquet Syndrome

Background Hair-thread tourniquet syndrome (HTTS) is the constriction of an appendage or tissue by a hair thread, which can cause ischemia and necrosis of distal tissues. Depilatory agents have the potential to release the hair tourniquet without exposing the patient to the risks of surgery.

OBJECTIVES

This review aims to evaluate the effectiveness, benefits, complications, and contraindications of depilatory agents in HTTS.

METHODS

Relevant terms to HTTS and depilatory agents were used to search for articles on MEDLINE and EMBASE databases using the NHS Healthcare Databases Advanced Search engine.

RESULTS

In total, 19 of the 295 articles identified in the primary search were included in the final review. Articles described the benefits of depilatory agents as painless, well tolerated, and non-invasive. Contraindications described include use on mucosal membranes, non-hair tourniquet, and allergy. Sixty-four percent (n = 55) of patients had resolution of their HTTS after one or two cycles of depilatory agent treatment.

CONCLUSIONS

The use of depilatory agents has multiple potential benefits. The authors propose a treatment algorithm for the use of depilatory agents in HTTS and recommend that all acute centers should store and train staff in their use.