Indian Journal of Surgery

, Volume 70, Issue 4, pp 161–168 | Cite as

Bedsores: “top to bottom” and “bottom to top”

  • Debashish Nayak
  • K. Srinivasan
  • Sadasivan Jagdish
  • Roma Rattan
  • Vinayaka S. Chatram
Review Article


Bedsore is a global problem concerning the bedridden, infirm, debilitated and malnourished patients in hospitals and community setups. The cost of treatment is enormous involving billions of dollars to nations and individuals. Mortality increases two to six times if bedsores are present. There is little research done despite its commonness to understand how they occur or why they occur; etiology is not much understood. The two theories called ‘top to bottom’ and ‘bottom to top’ contradict each other. It is thought that ‘pressure’, shear-stress’ and ‘ischemia’ may be causing it in some yet to be understood way.

There is little awareness on how to prevent them or how to treat them if they do occur. Seldom applied, various scales exist and should be used to identify patients at high risk. Braden scale is the most tested and widely accepted scale. The various available dressings and pressure relief devices are mostly inadequately studied; which is superior is a question that begs an answer. This article aims to underline the importance of bedsores by reviewing our current and past knowledge with emphasis on practical implications thereof.


Pressure ulcer Bedsores Decubitus ulcer Ischemia 


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Copyright information

© Association of Surgeons of India 2008

Authors and Affiliations

  • Debashish Nayak
    • 1
  • K. Srinivasan
    • 1
  • Sadasivan Jagdish
    • 1
  • Roma Rattan
    • 1
  • Vinayaka S. Chatram
    • 2
  1. 1.Department of SurgeryJawarharlal Institute of Post Graduate Medical Education and ResearchPondicherryIndia
  2. 2.Department of SurgeryShri Lakshminarayana Institute of Medical Sciences (SLIMS)PondicherryIndia

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