Bedsores: “top to bottom” and “bottom to top”
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.
KeywordPressure ulcer Bedsores Decubitus ulcer Ischemia
Unable to display preview. Download preview PDF.
- 2.Malone JR, McInnes E (2001) Pressure ulcer risk assessment and prevention (Recommendations 2001). Royal College of NursingGoogle Scholar
- 4.Kosiak M, Kubucek WG, Olson M, Danz JN, Kottke FJ (1959) Evaluation of pressure as a factor in the production of ischial ulcers. Arch Phys Med Rehabil 40(2):623–629Google Scholar
- 7.Sharp CA, McLaws ML (2005) A discourse on pressure ulcer physiology: the implications of repositioning and staging. World Wide WoundsGoogle Scholar
- 9.Braden B, Bergstrom N (1992) Pressure ulcers in adults: Prediction and Prevention. Clinical Practice Guideline, no.3, pp. 14–17Google Scholar
- 13.Pressure Ulcer Risk Assessment and prevention; Clinical Guidelines B. National Institute of Clinical Excellence, London 2005Google Scholar
- 14.American Medical Directors Association, Pressure Ulcer Therapy Companion: Clinical Practice Guidelines. Columbia, Md: AMDA, 1999Google Scholar
- 15.Clark M, Cherry G, Colin D, Defloor T (2006) Science and Practice of pressure ulcer management; Ramanetti M (Ed). SpringerGoogle Scholar
- 16.Moore ZEH, Cowman S (2007) Wound cleansing for pressure ulcers. The Cochrane library, John Wiley and SonsGoogle Scholar
- 17.Pownell PH (1995) Pressure sores, Selected Readings in Plastic Surgery. Plast Surg 7(39):1–27Google Scholar
- 19.Bader DL (2007) Pressure ulcer research; current and future perspectives, SpringerGoogle Scholar