Abstract: Objective To investigate the risk factors for vascular crisis after replantation surgery for finger amputation injuries.Methods A total of 181 patients who underwent replantation surgery for finger amputation injuries in our hospital from January 2024 to September 2025 were enrolled.According to postoperative outcomes, patients who developed vascular crisis were assigned to the observation group(46 cases), while the remaining patients were assigned to the control group(135 cases).Clinical data were compared between the two groups, and Logistic regression analysis was performed to identify risk factors for postoperative vascular crisis.Based on the results of the Logistic regression analysis, a nomogram prediction model was established, and calibration curves were used to evaluate the performance of the model.Results Among the 181 patients with finger amputation injuries who underwent replantation surgery included in this study, 46 cases (25.41%, 46/181) developed postoperative vascular crisis.The proportion of patients with a smoking history in the observation group (with vascular crisis) was 60.87% (28/46), significantly higher than 36.30% (49/135) in the control group; similarly, the proportion of patients with rotational avulsion injuries in the observation group was 34.78% (16/46), also significantly higher than 15.56% (21/135) in the control group(P＜0.05).The average finger ischemia time [(10.03±2.14)hours], operative time [(171.19±20.65)minutes] and postoperative SAS score [(58.13±6.78)points] in the observation group were all significantly higher than those in the control group [(7.19±1.68)hours, (143.08±16.32)minutes and (51.13±6.02)points, respectively].There was a statistically significant difference between the two groups (P<0.05).Regarding vascular repair, the proportion of patients who underwent only one arterial repair in the observation group was 65.22% (30/46), significantly higher than 38.52% (52/135) in the control group; the proportion of patients with no venous repair (0 veins) was as high as 45.65% (21/46) in the observation group, also significantly higher than 17.78% (24/135) in the control group.There was a statistically significant difference between the two groups (P<0.05).Multivariate Logistic regression analysis further confirmed that smoking history, finger ischemia time, operative time, number of arterial and venous repairs, rotational avulsion injury, and postoperative anxiety are independent risk factors for postoperative vascular crisis(P＜0.05).The nomogram prediction model established based on these factors shows a calibration curve that closely approximates the ideal curve, indicating high predictive value.Conclusion Smoking history, finger ischemia time, operative time, number of venous repairs, rotational avulsion injury, and postoperative anxiety are independent risk factors for vascular crisis after finger replantation.The nomogram prediction model constructed based on these factors shows high predictive value.

Key words: amputated fingers; replantation of amputated fingers; vascular crisis; risk factor