Development and validation of a nomogram predicting the risk of necrosis in fingertip replantation: a single-center retrospective study - Report - MDSpire
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Creation and assessment of a nomogram for estimating necrosis risk following fingertip replantation: a retrospective analysis from a single institution

  • By

  • Yadong Li

  • Xinwei Hou

  • Shuai Dong

  • Yan Zhang

  • Zhongliang Wang

  • Jihui Ju

  • Guangzhe Jin

  • September 15, 2026

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Clinical Report: Creation and assessment of a nomogram for estimating necrosis risk

Overview

This study developed and validated a nomogram to estimate necrosis risk following fingertip replantation based on clinical and early postoperative data.

Background

Fingertip replantation is a common procedure in hand surgery, particularly in regions with high rates of hand injuries. Despite advancements in microsurgical techniques, necrosis remains a significant complication that can affect patient outcomes. Understanding risk factors for necrosis can aid in clinical decision-making.

Data Highlights

MetricDerivation CohortValidation Cohort
Patients942402
Necrosis Rate12.2%11.9%
AUC0.9530.974
Brier Score0.0510.042

Key Findings

  • The nomogram includes six predictors: surgeon experience, PLT, NEU%, D-dimer, hypertension, and vascular crisis.
  • Discrimination was strong with AUC values of 0.953 for the derivation cohort and 0.974 for the validation cohort.
  • The Brier scores were 0.051 for the derivation cohort and 0.042 for the validation cohort, indicating good predictive accuracy.
  • Calibration in the internal validation cohort showed an intercept of -0.338 and a slope of 0.759.
  • Necrosis affected 115 patients (12.2%) in the derivation cohort and 48 patients (11.9%) in the validation cohort.

Clinical Implications

The nomogram provides a tool for early postoperative risk stratification of necrosis in fingertip replantation.

Conclusion

The internally validated nomogram estimates necrosis risk following fingertip replantation, although external validation is necessary.

Related Resources & Content

  1. Frontiers in Medicine, 2026 -- A nomogram for predicting free flap necrosis in soft tissue reconstruction of lower limbs: a retrospective cohort study
  2. Frontiers in Surgery, 2026 -- Replantation of amputated fingertips: reconstruction of circulation via proximal subungual arch artery or nail bed vein anastomosis
  3. Springer, 2021 -- Predicting Severe Postoperative Complications in Pancreatic Head Resection: A Nomogram-Based Approach for Clinical Decision-Making
  4. ACOEM Hand, Wrist, and Forearm Disorders, 2025 -- Guidelines
  5. PubMed, 2023 -- Perioperative Assessment and Management of Hypercoagulability and Thrombophilia in Microsurgery: Consensus Report of the German-Speaking Society for Reconstructive Microsurgery (GSRM)
  6. Reconstruction of the Thumb Following Radical Tumor Resection Utilizing a Free Osteocutaneous Lateral Arm Flap with Subsequent Humerus Fracture: A Case Study
  7. Risk factors associated with postoperative necrosis after digital replantation: a systematic review and meta-analysis
  8. Postoperative vascular compromise after digital replantation or revascularization: timing, risk factors, and salvage outcomes in a single-center retrospective cohort
  9. ACOEM Hand, Wrist, and Forearm Disorders
  10. [Perioperative Assessment and Management of Hypercoagulability and Thrombophilia in Microsurgery: Consensus Report of the German-Speaking Society for Reconstructive Microsurgery (GSRM)].
  11. Frontiers | Development and validation of a nomogram predicting the risk of necrosis in fingertip replantation: a single-center retrospective study
  12. Development and validation of interpretable machine learning models for predicting the risk of necrosis after finger replantation: A retrospective multicenter study - ScienceDirect

Original Source(s)

Development and validation of a nomogram predicting the risk of necrosis in fingertip replantation: a single-center retrospective study

  • by Yadong Li, Xinwei Hou, Shuai Dong, Yan Zhang, Zhongliang Wang, Jihui Ju, Guangzhe Jin

  • September 15, 2026

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