Preoperative serum von willebrand factor, e-selectin, and tumor necrosis factor-alpha predict early venous outflow dysfunction after finger replantation

Background: Early venous outflow dysfunction is a leading cause of early failure after finger replantation. This study evaluated whether preoperative serum markers of endothelial activation and inflammation can predict early venous outflow dysfunction and developed a serumbased risk model. Methods: This retrospective cohort included 150 patients who underwent finger replantation between January 2022 and October 2025. Peripheral venous blood was collected 2 h before surgery. Serum von Willebrand factor (vWF), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-a) were measured. Early venous outflow dysfunction was defined as venous congestion requiring intervention within 72 h postoperatively. Independent markers were identified using multivariable logistic regression. Model performance was assessed by receiver operating characteristic analysis (AUC with 95% confidence intervals by the DeLong method and betweenmodel comparison by the DeLong test), calibration by the Hosmer-Lemeshow test, and internal validation using bootstrap resampling (200 iterations). Results: All seven biomarkers were higher in cases (n=74) than controls (n=76) (P