{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:05:19Z","timestamp":1789452319262,"version":"build-2803163510"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009942; 70%) and a split-sample internal validation cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009402; 30%). Candidate predictors were reduced by 10-fold cross-validated least absolute shrinkage and selection operator regression. A multivariable logistic regression model was specified using six predictors available during the early postoperative course. Discrimination, calibration, Brier score, and decision-curve analysis were evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u20130.968) in the derivation cohort and 0.974 (95% CI, 0.958\u20130.987) in the internal validation cohort. Corresponding Brier scores were 0.051 and 0.042. In the internal validation cohort, the calibration intercept was \u22120.338 and the calibration slope was 0.759; the Hosmer\u2013Lemeshow test yielded\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.729. Decision-curve analysis suggested potential net benefit across clinically plausible threshold probabilities, but external validation is required.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1926687","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:36:28Z","timestamp":1789450588000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a nomogram predicting the risk of necrosis in fingertip replantation: a single-center retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yadong","family":"Li","sequence":"first","affiliation":[{"name":"Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital","place":["Suzhou, Jiangsu, China"]},{"name":"Suzhou Medical College of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital","place":["Suzhou, Jiangsu, China"]},{"name":"Suzhou Medical College of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongliang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihui","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital","place":["Suzhou, Jiangsu, China"]},{"name":"Suzhou Medical College of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangzhe","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital","place":["Suzhou, Jiangsu, China"]},{"name":"Suzhou Medical College of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1002\/micr.30738","article-title":"Comparing digital replantation versus revision amputation patient reported outcomes for traumatic digital 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