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The Diabetic
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Letter: Clinic currently testing the S(AD) SAD classification system

LuÍs Serra

The diabetic foot is a huge problem among Portuguese patients with diabetes. Some of the reasons for this are the lack of organised primary care for the prevention of diabetic foot problems, poor sanitary conditions and differentiated care centres.

Since 1987, we have run a multidisciplinary foot clinic in Oporto, which has helped to reduce the high amputation rate.

All of us had already felt the need to establish a plan for the treatment and prognosis of different types of diabetic foot. We realised the need for a classification that was objective, simple and robust to provide a common language for discussion among different diabetic foot care centres.

The classification suggested by Macfarlane and Jeffcoate (1999) in the last issue of The Diabetic Foot seems to cover all the main points of the observation of diabetic foot ulcers. Among other classifications of this kind proposed previously, San Antonio’s was the most complete; however, it is difficult to use, and is not as complete as it might at first appear because it ignores the different stages of denervation.

We are already testing the classification in our clinic. The initials S(AD) SAD are better because they are easy to remember and applicable in both clinical and investigation areas.

Even in a multidisciplinary centre like ours with a large number of patients (300 first appointments and about 4000 second appointments per year), this classification does not seem to incur additional work, but instead is very helpful.

It is still too early for us to have a solid opinion; however, our use of the S(AD) SAD system so far has resulted in no difficulties in classifying new patients with regard to their gravity (area and depth), prognosis (grade of sepsis) and aetiology (ischaemia or denervation).

We intend to test this method on all first appointments from now on, to determine its efficacy for future clinic investigations.

The diabetic foot is a huge problem among Portuguese patients with diabetes. Some of the reasons for this are the lack of organised primary care for the prevention of diabetic foot problems, poor sanitary conditions and differentiated care centres.

Since 1987, we have run a multidisciplinary foot clinic in Oporto, which has helped to reduce the high amputation rate.

All of us had already felt the need to establish a plan for the treatment and prognosis of different types of diabetic foot. We realised the need for a classification that was objective, simple and robust to provide a common language for discussion among different diabetic foot care centres.

The classification suggested by Macfarlane and Jeffcoate (1999) in the last issue of The Diabetic Foot seems to cover all the main points of the observation of diabetic foot ulcers. Among other classifications of this kind proposed previously, San Antonio’s was the most complete; however, it is difficult to use, and is not as complete as it might at first appear because it ignores the different stages of denervation.

We are already testing the classification in our clinic. The initials S(AD) SAD are better because they are easy to remember and applicable in both clinical and investigation areas.

Even in a multidisciplinary centre like ours with a large number of patients (300 first appointments and about 4000 second appointments per year), this classification does not seem to incur additional work, but instead is very helpful.

It is still too early for us to have a solid opinion; however, our use of the S(AD) SAD system so far has resulted in no difficulties in classifying new patients with regard to their gravity (area and depth), prognosis (grade of sepsis) and aetiology (ischaemia or denervation).

We intend to test this method on all first appointments from now on, to determine its efficacy for future clinic investigations.

REFERENCES:

Macfarlane R, Jeffcoate W (1999) Classification of diabetic foot ulcers: The S(AD) SAD System. The Diabetic Foot 2(4)123-31

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