Videocapillaroscopy of the Oral Mucosa in Patients with Diabetic Foot: Possible Diagnostic Role of Microangiopathic Damage?

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Abstract

Introduction: Diabetic foot represents one of the most serious and expensive complicationsof diabetes and is subject to a high percentage of amputations that are almost always preceded byulcers ascribable to neuropathy and/or vasculopathy. Videocapillaroscopy (VCS) can be a valuableaid in order to uncover morpho-structural anomalies in the vascular bed, both at the level of the oralmucosa and at the level of the terminal vessels of the lower limb. Materials and methods: Sixtysubjects divided into 4 groups were enrolled: 15 healthy subjects; 15 patients with diabetes for morethan 10 years without ulcerative foot lesions; 15 patients with neuropathic diabetic foot (clinicaldiagnosis, MDNS); 15 patients with ischemic diabetic foot (clinical diagnosis, ABI, lower limbdoppler). A complete videocapillaroscopic mapping of the oral mucosa was carried out on eachpatient. The areas investigated were: labial mucosa, the retro-commissural region of the buccalmucosa, and the vestibular masticatory mucosa (II and V sextant). Results: The analysis of themorphological and densitometric characteristics of the capillaries revealed the following: asignificant reduction in capillary density in neuropathic (mean ± SD 7.32 ± 2.1) and ischemic patients(mean ± SD 4.32 ± 3.2) compared to the control group of patients (both diabetic mean ± SD 12.98 ±3.1 and healthy mean ± SD 19.04 ± 3.16) (ANOVA test and Bonferroni t test p < 0.05); a reduction inthe average length of the capillaries and a significant increase in tortuosity (ANOVA test andBonferroni t test p < 0.05). In the neuropathic patients, a recurrent capillaroscopic pattern that wedefined as “sun” was found, with capillaries arranged radially around an avascular area.Conclusions: The data obtained from this preliminary study suggest a potential diagnostic role oforal capillaroscopy in the early and subclinical identification of microangiopathic damage inpatients with diabetic foot.
Original languageEnglish
Number of pages9
JournalJournal of Clinical Medicine
Volume9
Publication statusPublished - 2020

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