ArticleFrontiers in surgery2026
Development and validation of a nomogram predicting the risk of necrosis in fingertip replantation: a single-center retrospective study.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Necrosis remains an important complication after fingertip replantation. We aimed to develop and internally validate a model for estimating necrosis risk using clinical, procedural, and early-postoperative information. Methods: We retrospectively analyzed 1,344 patients who underwent replantation of 1,497 fingertips at a single center between August 2018 and August 2023. The patient was the unit of analysis. Patients were divided by outcome-stratified random sampling (seed 2222) into a derivation cohort ( Results: Necrosis occurred in 115 patients (12.2%) in the derivation cohort and 48 (11.9%) in the internal validation cohort. The model retained surgeon experience, platelet count (PLT), neutrophil percentage (NEU%), D-dimer, hypertension, and vascular crisis. The area under the receiver operating characteristic curve was 0.953 (95% CI, 0.935-0.968) in the derivation cohort and 0.974 (95% CI, 0.958-0.987) in the internal validation cohort. Corresponding Brier scores were 0.051 and 0.042. In the internal validation cohort, the calibration intercept was -0.338 and the calibration slope was 0.759; the Hosmer-Lemeshow test yielded Conclusion: This split-sample internally validated nomogram estimates necrosis risk after fingertip replantation once early-postoperative laboratory results and vascular-crisis status are available. The observed discrimination should be interpreted alongside calibration shrinkage, possible overfitting, and the absence of external validation.
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