Size (area, depth), sepsis, arteriopathy, denervation system The S(AD) SAD system.
The Size (area, depth), Sepsis, Arteriopathy, and Denervation (S(AD)SAD) system, introduced in 1999, was primarily designed for clinical audits. It underwent verification in 2004 and has been refined over time for prospective research. This system encompasses five elements—size (area, depth), infection (sepsis), ischemia (arteriopathy), and neuropathy (denervation)—each graded from 0 to 3 based on severity. The S(AD)SAD system employs acronyms for easy memorization and generalization of features. It offers the advantage of enabling specific ulcer recording without the need for specialized testing technology, making it practical for clinical settings. However, due to the numerous characteristics and intricate details of ulcers, operators may find it challenging to recall. As a result, the S(AD)SAD system is often favored for audits, while the UT system is preferred for clinical description and communication.
| Grade | Size (Area) | Depth | Sepsis | Arteriopathy | Denervation |
|---|---|---|---|---|---|
| 0 | Skin intact | Skin intact | None | Pedal pulses present | Pin pricks sensation intact/ vibration perception threshold (VPT) normal |
| 1 | < 1 cm² | Superficial (skin and subcutaneous tissue) | Surface | Pedal pulses reduced or one missing | Pin pricks sensation reduced or absent/ VPT raised |
| 2 | 1-3 cm² | Tendon, periosteum, joint capsule | Cellulitis | Absence of both pedal pulses | Neuropathy as dominant factor contributing to the ulcer: Absent pinprick sensation, with palpable pedal pulses |
| 3 | > 3 cm² | Bone or joint space | Osteomyelitis | Gangrene | Charcot foot |
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