Scalp Flap Transfer in Sofia BG
Scalp Flap Transfer
Several medical conditions can produce baldness, such as illness, poor nutrition and thyroid imbalance. Most baldness is not caused by illness, but is an inherited trait.
Bald men with vertex (crown of the head) balding may benefit substantially from scalp flap transfer, with proper preoperative planning, and when the procedure is performed by a skilled, experienced physician hair restoration specialist.
Scalp flap transfer is a technique that involves the transfer of large strips of hair-bearing scalp on the sides of the head (located above the ears) to an area of scalp without hair. The size and placement of the flap will be as per the patient’s needs. The area from which it is removed is closed with stitches. The scar left after the operation will be hidden by the relocated hair. The hair transferred to the new location continues to grow at the same rate and with the same density as the original location. It is the most efficient way to move the greatest amount of hair in the shortest period of time.
Scalp flap transfer aims to repair a non-traumatic cosmetic defect. It also repairs a traumatic injury site and restores its functionality and cosmetic appearance. Another objective of scalp flap surgery is repairing a skin defect resulted by congenital malformation.
Cosmetic and reconstructive scalp flap transfer uses two types of flaps - pedicle flaps and free flaps.
Pedicle flaps are surgically removed from the donor site and transferred to the recipient site with an attached pedicle of tissues. This pedicle of tissues contains the flap’s artery-vein blood supply along with the flap tissues. The transfer of artery-vein blood supply along with the flap boosts the survival and health of the transferred tissue. Pedicle flaps are most often used for cosmetic hair restoration.
Free flaps are transferred from the donor site to the recipient site without any attached pedicle. But it must contain arteries and veins reattached to blood vessels at the recipient site by micro vascular surgery. These flaps are regularly used in reconstructive surgery when local skin is insufficient to raise a pedicle flap to cover a defect.
Risks of scalp flap transfer:
• Blood supply failure to the flap due to pressure on the flap’s blood supply that can result in partial or total loss of the flap.
• Nerve transaction during surgery that can cause loss of feeling over all or part of the scalp.
• Scarring at donor or recipient sites.
• Permanent hair loss at donor sites.
The discomfort of this operation is minimal. A dressing is worn for three to four days; no hair is cut during any of these procedures so the hair may be shampooed and styled immediately after dressings are removed. The stitches at the hairline are removed after six days; after ten to fourteen days, the stitches behind the Flap and on the side of the head are removed.
Advantages of scalp flap transfer:
• Excellent frontal scalp coverage
• Natural frontal hairline
• Excellent hair placement in temporal areas
• Good hair direction
• Avoidance of hair pattern distortion
These surgical procedures can be performed on an out-patient basis under either general or I.V. anesthesia.
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Sofia Get around
To get around Sofia you can use several means of transport: public autobuses, some trolley lines, many tram lines, a subway line and private mini-buses (mini-vans).
The public transport in Sofia works from 5 am to about 11 pm. Price per ticket is 0,70 leva (about 0,35 euro) if you buy it from a kiosk. Tickets should be bought before you get in the bus. When you board the bus, find the punches in order to punch the ticket. Unpunched ticked is invalid. The bus control rarely understand English and you might have problems with the security if you travel without a ticket or even with unpunched one. If you come to Sofia by plane, take bus#284 from the airport to the center, if you come by train or bus, to the center, take public bus #305, #213 or #214 (to Orlov Most) or tram #1, #7, (to Sveta Nedelya square) #6, #9, (to the National Palace of Culture) #12 (to Slaveykov square) or #19 (to Macedonia square).
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Plastic Surgery News...
- The Annals of Internal Medicine have featured guidelines on the current pharmacological treatment of dementia as published by the American College of Physicians and American Academy of Family Physicians.
The review in the Annals discusses dementia related to Alzheimer’s disease and vascular dementia, and discusses the evidence for approved pharmacological therapies, for outcomes in the domains of cognition, global function, behaviour/mood, and quality of life/activities of daily living. The guidelines conclude with the following recommendations (as taken directly from source):
Recommendation 1: Clinicians should base the decision to initiate a trial of therapy with a cholinesterase inhibitor or memantine on individualised assessment. (Grade: weak recommendation, moderate-quality evidence.)
Recommendation 2: Clinicians should base the choice of pharmacological agents on tolerability, adverse effect profile, ease of use, and cost of medication. The evidence is insufficient to compare the effectiveness of different pharmacological agents for the treatment of dementia. (Grade: weak recommendation, low-quality evidence.)
Recommendation 3: There is an urgent need for further research on the clinical effectiveness of pharmacological management of dementia.
The Annals also features a related review of the literature discussing the evidence for the effectiveness of cholinesterase inhibitors (donepezil, galantamine, rivastigmine, and tacrine) and the neuropeptide-modifying agent memantine in achieving clinically relevant improvements, primarily in cognition, global function, behaviour, and quality of life, for patients with dementia. This review forms the basis of the guidelines.
- A RADAR (Rational Assessment of Drugs and Research) review on the use of fentanyl lozenges (Actiq) for breakthrough cancer pain has been published and is available to access via the link above. This review was completed on behalf of the National Prescribing Service (NPS), which is an independent Australian organisation supporting the quality use of medicines. The authors make the following conclusions and recommendations (taken directly from the source):
• Fentanyl lozenges are an oromucosal formulation for breakthrough cancer pain in people stabilised on regular opioid therapy for persistent cancer pain.
• Oral morphine is the opioid of first choice on the basis of familiarity, cost and dosing flexibility. Consider fentanyl lozenges if an increase in morphine dose to control breakthrough pain causes intolerable adverse effects.
• Be aware of the following important safety issues:
- Do not use fentanyl lozenges in opioid-naïve patients because of the risk of respiratory depression.
- Prevent accidental or deliberate misuse by instructing patients and carers on the correct use, storage and disposal of fentanyl lozenges.
- Keep intact or partially used lozenges away from children.
• To maximise oromucosal absorption of fentanyl, the lozenges should be moved along the cheek lining, not chewed, and swallowing of saliva minimised if possible until the lozenge is finished.
• Fentanyl lozenges have a side-effect profile typical of that of other opioids. Instruct patients and carers to remove the lozenge immediately if excessive side effects occur during use.
• There is no dose equivalence between fentanyl lozenges and other opioid formulations. The optimal dose cannot be predicted by the dose of regular opioid or previous breakthrough opioid. It should be individually titrated by starting at the lowest dose (200 micrograms).