Meta-analysis identifies risk factors for necrosis after finger replantation

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Frontiers in Medicine Published April 14, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider smoking, long ischemic time, crush injury, thrombosis, and vein graft as risk factors for necrosis after replantation.

This systematic review and meta-analysis pooled data from studies involving 3,645 patients undergoing finger replantation to identify risk factors for postoperative necrosis. The analysis examined associations between various factors and the primary outcome of overall postoperative necrosis. No specific comparator was reported for the risk factor exposures.

The main results, reported as odds ratios (ORs) with 95% confidence intervals, showed significant associations with increased risk of necrosis. The strongest association was with thrombosis (OR 4.98, 95% CI 1.49 to 16.67). Other associated factors included smoking (OR 3.48, 95% CI 1.96 to 6.17), crush injury (OR 2.77, 95% CI 1.41 to 5.43), preoperative ischemic time of 8 hours or more (OR 2.25, 95% CI 1.43 to 3.54), and the use of a vein graft (OR 1.56, 95% CI 1.19 to 2.04). Absolute event numbers were not reported.

Safety and tolerability data were not reported. A key limitation is that outcome definitions for necrosis were not fully consistent across the included studies, which may affect the comparability and interpretation of the pooled results. The funding source and potential conflicts of interest were not reported.

For practice, this analysis provides aggregated observational evidence that can support perioperative risk assessment and clinical decision-making in finger replantation. However, clinicians should recognize that these are associations, not proven causal relationships, and the inconsistency in outcome definitions warrants caution when applying these findings to individual patients.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

BackgroundSystematically evaluate and quantitatively analyze risk factors associated with necrosis following replantation surgery for amputated fingers, providing evidence-based support for perioperative risk assessment and clinical decision-making.MethodsSystematically searched PubMed, Embase, Web of Science, Cochrane Library, and CNKI, Wan fang, VIP for all observational studies from indexing to January 1, 2026. Cohort studies reporting overall postoperative necrosis after finger replantation, as defined in the original studies, and its associated factors were included. The Newcastle–Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Pooled effect sizes were extracted, and pooled odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated using a random-effects model.ResultsA total of 12 studies involving 3,645 patients were included. Meta-analysis results suggest smoking [OR = 3.48, 95% CI (1.96, 6.17)], preoperative ischemic time ≥8 h [OR = 2.25, 95% CI (1.43, 3.54)], crush injury [OR = 2.77, 95% CI (1.41, 5.43)], thrombosis [OR = 4.98, 95% CI (1.49, 16.67)], vein graft [OR = 1.56, 95% CI (1.19, 2.04)] may be associated with necrosis after digital replantationConclusionThis study suggests that smoking, preoperative ischemia duration ≥8 h, crush injury, thrombosis, and venous grafting may be associated with an increased risk of overall postoperative necrosis following finger replantation. These findings should be interpreted with caution because outcome definitions were not fully consistent across studies.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261290184.