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.
Lingua originaleEnglish
Numero di pagine9
RivistaJournal of Clinical Medicine
Volume9
Stato di pubblicazionePublished - 2020

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