Dhaga Syndrome: A Perplexing Dilemma of "What Lies Beneath".

“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 1a]. 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

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 1b]. We were able to take out the thread, and the patient was uneventfully discharged [Figure 1c]. On follow-up, she has no sequelae of the event.

Dhaga syndrome is a rarely encountered entity.[12] 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.[12]

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.[12] 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.[12]

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.

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Conflicts of interest

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