Application of the S (AD) SAD System as a Prognostic and Evaluation Tool for the Multidisciplinary Treatment of a Diabetic Foot Ulcer

Introduction: Foot ulcers combined with infection is one of the main complications of type 2 diabetes mellitus (DM2), and when not diagnosed and treated, amputation is the most frequent outcome. Thus, patients with DM2 are ten times more likely to be hospitalized for infections when compared to normal ones. For this reason, it is indisputable that diabetic foot ulcers have a major impact on health and the early approach can reduce the chances of amputations. Case Report: A 48-year-old woman, admitted with an ulcer on her right foot for 30 days, reports worsening and pain for 7 days. Previous history of DM2 diagnosed 2 years ago, using metformin irregularly. On physical examination, he had edema, flushing, impaired tibial pulses and ulcer in the calcaneus with exudate in the right lower limb. In addition, he had a BMI of 32.5, showing overweight. Having considered the hypothesis of a diabetic foot associated with hyperglycemia, the S (AD) SAD system (SEPSIS, ARTERIOPATY, DENERVATION) was applied, in order to assess the prognosis of foot ulcer (healing), setting a score of 10 due to the presence of an affected area greater than 3 cm², affected depth up to the joint capsule, presence of osteomyelitis, reduced pulses, and reduced sensitivity at the site. In this sense, the system suggested an expectation for cure in a period greater than 6 months and with a high risk for limb amputation. The exams were consistent with the hypothesis of hyperglycemia, revealing decompensated diabetes mellitus. Thus, he presented elevated glycated hemoglobin (11.8%), estimated mean glycemia (292 ml / dL), and elevated basal glucose (191 mg / dL). Treatment with antibiotic therapy was initiated for 30 days and the patient was asked to go to the health service three times a week to perform debridement with SF 0.9% and apply the ionic silver dressing to treat the ulcer. In addition, the patient received guidance related to dietary reeducation, and started treatment with empagliflozin to control DM2. The patient progressed with progressive ulcer healing and weight reduction. After 3 months of treatment, after monitoring and multidisciplinary intervention, the patient had an adequate glycated hemoglobin rate (6.9%) and the patient achieved total healing of the ulcer, with improved sensitivity and peripheral circulation of the affected limb. Conclusion: Although ulcers are a frequent problem, there are difficulties not only in choosing the most appropriate approach, but also in a system that provides a prognosis and that makes it possible to assess the risk of amputation. Therefore, the S (AD) SAD system, a reproducible tool that favored decision making, provided a prognosis for slow healing and a high risk for amputation. Thus, the multidisciplinary team was able to measure the severity of the condition, choose a treatment, and evaluate the success of the approach adopted, which configured the total healing in 3 months.