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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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LETTERS TO THE EDITOR
Year : 2019  |  Volume : 24  |  Issue : 4  |  Page : 317-318
 

Dhaga syndrome: A perplexing dilemma of “What Lies Beneath”


1 Department of General Surgery, Pediatric Surgery Unit, Amaltas Institute of Medical Sciences, Dewas, Madhya Pradesh, India
2 Department of General Surgery, Plastic Surgery Unit, Amaltas Institute of Medical Sciences, Dewas, Madhya Pradesh, India
3 City Hospital and Research Centre, Dewas, Madhya Pradesh, India

Date of Web Publication29-Aug-2019

Correspondence Address:
Dr. Saurabh Shyam Garge
Department of General Surgery, Pediatric Surgery Unit, Amaltas Institute of Medical Sciences, Dewas, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_228_18

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How to cite this article:
Garge SS, Paliwal G, Lodwal B. Dhaga syndrome: A perplexing dilemma of “What Lies Beneath”. J Indian Assoc Pediatr Surg 2019;24:317-8

How to cite this URL:
Garge SS, Paliwal G, Lodwal B. Dhaga syndrome: A perplexing dilemma of “What Lies Beneath”. J Indian Assoc Pediatr Surg [serial online] 2019 [cited 2019 Nov 18];24:317-8. Available from: http://www.jiaps.com/text.asp?2019/24/4/317/265705




“Dhaga syndrome” is a rare entity seen in younger children, mainly in communities where threads are worn around the wrist for decorative or religious purposes.[1]

A 10-month-old girl presented with a history of a linear circumferential scar at the right wrist and limited use of the right hand for several days. On questioning, the mother said that a kite thread (Maanja) was accidentally applied on the right wrist while playing. They did not realize the same until they saw a fine white-colored thread emerging from a discharging sinus. The parents sought medical attention for the same and were advised antibiotics and local ointment applications by a local practitioner, who also tried removing the thread. The patient was thus referred to us.

On presentation, there was a circumferential linear red scar with partial healing on the right wrist, and a discharging sinus was seen with a thread protruding out from the lateral side [Figure 1]a. There was mild swelling of the hand; however, both the radial and ulnar pulses were well felt. An X-ray of the hand was unremarkable. We planned operating upon the patient as the history was not very long standing and the thread was seen treading superficially.
Figure 1: (a) A linear constricting red scar with discharging sinus showing a white thread, (b) thread seen from two Z plasty incisions, (c) removed thread

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Multiple Z plasties were done in order to release the constricting band and to avoid cutting the thread. A white-colored thread was seen in the subcutaneous plane, away from the deeper neurovascular structures [Figure 1]b. We were able to take out the thread, and the patient was uneventfully discharged [Figure 1]c. On follow-up, she has no sequelae of the event.

Dhaga syndrome is a rarely encountered entity.[1],[2] Usually, children afflicted are between 10 months and 4 years. At these ages, children are usually chubby, have restricted vocal abilities, and have rapid physical growth.[1],[2]

Clinical presentation can be acute where the child presents with compartment syndrome or can be chronic where the symptoms are functional related to damage to deeper structures.[1],[2] Surgical procedures are based on the presentation. Surgical incisions should never be longitudinal, as there is a risk of cutting the band, making its retrieval difficult. Thus, a lazy S incision or multiple Z-plasties can be used for exploration. The length of these incisions is directly proportional to the depth of involvement and the severity of damage.[1],[2]

The cardinal features of a linear constricting scar around the wrist in the presence of a swollen hand should always alert the clinician to the possibility of a forgotten band around the wrist, which might have burrowed into the soft tissues for a period. Early recognition may be important to prevent further damage of essential structures.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Agarwal A, Kant KS, Verma I. The rubber band syndrome: The forgotten rubber band in the wrist. Hand Surg 2013;18:407-10.  Back to cited text no. 1
    
2.
Meier R, Haug L, Surke C, Mathys L, Vögelin E. Acquired constriction ring: A case of rubber band syndrome. Pediatr Emerg Care 2019;35:e113-5.  Back to cited text no. 2
    


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