digit or genitalia This often occurs during a bath, or as a result of wiggling of the toes in a sock, shoe, or mitten that inadvertently has a hair or loose thread in it A hair shed from a parent during diapering is the probable source of penile tourniquets As the hair or thread becomes more tightly entwined, it produces a tourniquet effect, impairing blood flow Initially, lower pressure venous blow flood is impaired This results in increased swelling, ultimately leading to impairment in arterial blood flow and ischemia if not identified and treated When noted early, the hair is often visible in a crease just proximal to the swollen area If identified later, the hair may have cut through the skin, making it difficult to visualize ( Fig 120.3 ) In rare cases, frank ischemic necrosis of the distal digit may be seen on presentation Removal requires fine-tipped forceps and the aid of a thin loupe or probe that is inserted proximally under the constricting hair Usually the hair can be unwound from the digit intact or cut with scissors When the hair is deeply embedded or there is any question of a remaining constricting band, a nerve block should be performed and a perpendicular incision made over the hair (see Chapter 130 Procedures ) To avoid damage to the underlying neurovascular structures, such an incision should be made on the lateral or ulnar aspect of a finger or toe at or o’clock or at or o’clock along the penile shaft While the use of depilatory creams for hair tourniquet removal has been described in case reports, their effectiveness has not been well established and should be avoided in children with lacerated skin When the entire hair cannot be removed with certainty, consultation with a plastic surgeon is indicated