Atorvastatin and nitroglycerin ointment in digit replantation: Associations with vascular crisis and circulating biomarkers

Background: Vascular crisis is a major threat to digit replantation success, leading to substantial failure rates and compromised functional recovery. Objectives: To assess the association of combined atorvastatin and nitroglycerin ointment with vascular crisis, circulating biomarkers and clinical outcomes in patients undergoing unilateral digit replantation. Methods: 184 patients were prospectively allocated to combination (atorvastatin + nitroglycerin) or control (nitroglycerin alone) groups. Vascular crisis incidence, serum biomarkers (TNF-?, IL-6, CRP, NO, eNOS, ET-1), microcirculation indices and 30-day digit survival were systematically monitored. Results: Combination therapy decreased vascular crisis incidence (6.52% vs. 16.30%, P=0.037) and improved 30-day digit survival (90.22% vs. 79.35%, P=0.040). Postoperatively, the combination group exhibited lower levels of TNF-?, IL-6, CRP and ET-1, along with higher NO/eNOS levels and improved microcirculation, with all differences statistically significant after Bonferroni correction (P<0.05). Conclusion: Atorvastatin combined with nitroglycerin ointment correlates with reduced vascular crisis and favorable 30-day outcomes, accompanied by beneficial shifts in biomarkers and microcirculation that may underpin the therapeutic effects.