Brachial Plexus Injury (BPI) is a significant medical condition that affects the network of nerves originating from the spinal cord and controlling the arm, hand, and shoulder.
This injury can result from various causes such as trauma, childbirth complications, or other underlying medical issues.
Patients with BPI may experience pain, weakness, or paralysis in the affected limb, impacting their quality of life and functional capabilities.
When seeking treatment, Turkey has become an attractive destination due to its combination of advanced medical care, experienced specialists, and cost-effective solutions.
Factors Influencing the Cost
Several factors impact the overall cost of Brachial Plexus Injury treatment in Turkey. Understanding these factors helps patients anticipate their expenses and make informed decisions:
Type of Procedure:
The specific surgical intervention required plays a significant role in determining the cost.
Complex procedures like nerve transfers or muscle transfers are generally more expensive than simpler nerve grafting surgeries due to the technical expertise and resources required.
Hospital and Clinic Choice:
The choice of medical facility can affect the cost of treatment. Major hospitals and specialized clinics in cities like Istanbul, Ankara, and Izmir may have higher fees compared to smaller or less well-known facilities.
However, larger institutions often provide advanced technology and experienced medical staff.
Surgeon’s Expertise:
The experience and reputation of the surgeon can influence the cost of the procedure.
Highly experienced or internationally recognized surgeons may charge higher fees for their services, reflecting their advanced skills and track record in treating complex cases.
Location:
The cost of treatment can vary by location within Turkey. Istanbul, as a major medical hub, tends to have higher costs compared to other cities like Ankara and Izmir.
However, the quality of care remains consistently high across the country.
Insurance Coverage:
Insurance coverage can significantly impact out-of-pocket expenses. Some international health insurance plans may cover a portion of the treatment costs, while others may not.
It is important for patients to verify their insurance coverage and understand the extent of their benefits before proceeding with treatment.
Prices of all types of the Brachial Plexus Injury procedure in Turkey.
Nerve Grafting
Definition and Details:
Nerve grafting is a sophisticated surgical technique used to repair nerves that have been damaged or severed due to trauma or injury.
In this procedure, a segment of a healthy nerve is taken from another part of the body and used to replace the damaged segment of the brachial plexus.
The primary goal of nerve grafting is to restore nerve continuity and facilitate nerve regeneration.
The success of this procedure depends on several factors, including the extent of nerve damage, the timing of the surgery (sooner is generally better), and the quality of the graft used. Surgeons aim to achieve optimal alignment and tension to enhance nerve recovery and function.
Procedure Steps:
Pre-Operative Consultation:
- Detailed assessment of the injury
- Diagnostic tests (e.g., EMG, nerve conduction studies)
- Treatment planning and discussion
Diagnostic Imaging:
- MRI or CT scans to visualize the extent of nerve damage
Surgical Procedure:
- Harvesting of the donor nerve
- Preparation and grafting of the nerve
- Suturing and alignment of the graft
Hospital Stay:
- Post-surgery observation and monitoring
Post-Operative Medications:
- Pain management and anti-inflammatory drugs
Rehabilitation:
- Physical and occupational therapy to regain function
Pricing Information:
- Pre-Operative Consultation: Cost: $100 to $250
- MRI Scan: $300 to $600
- CT Scan (if needed): $200 to $500
- Nerve Grafting Surgery: $5,000 to $8,000
- Cost per Night: $200 to $500
- Post-Operative Medications: Cost: $100 to $300
- Physical Therapy Sessions: $50 to $150 per session
- Total Rehab Cost: $2,000 to $5,000
Nerve Transfer
Definition and Details:
Nerve transfer is a surgical technique designed to restore function to damaged nerves by redirecting healthy nerves to replace the damaged ones.
This procedure is particularly useful when nerve damage is extensive and cannot be repaired effectively by grafting alone.
During nerve transfer, a functioning nerve from a different part of the body (often from a less critical area) is connected to the target nerve.
This approach aims to reestablish motor and sensory function in the affected limb by leveraging the healthy nerve’s functionality.
The success of nerve transfer depends on accurate surgical technique, the quality of the donor nerve, and the patient’s overall health.
Procedure Steps:
Pre-Operative Consultation:
- Comprehensive evaluation of the injury
- Discussion of treatment options and goals
Diagnostic Imaging:
- MRI or CT scans to assess nerve damage and plan the transfer
Surgical Procedure:
- Identification and preparation of the donor nerve
- Re-routing of the donor nerve to the damaged nerve
- Suturing and securing the connections
Hospital Stay:
- Post-surgery care and monitoring
Post-Operative Medications:
- Prescribed medications for pain and inflammation
Rehabilitation:
- Therapy to support nerve function and muscle strength
Pricing Information:
- Pre-Operative Consultation: Cost: $100 to $250
- MRI Scan: $300 to $600
- CT Scan (if required): $200 to $500
- Nerve Transfer Surgery: $6,000 to $9,000
- Hospital Stay: Cost per Night: $200 to $500
- Post-Operative Medications: Cost: $100 to $300
- Physical Therapy Sessions: $50 to $150 per session
- Total Rehab Cost: $2,000 to $5,000
Muscle Transfer
Definition and Details:
Muscle transfer surgery involves relocating a healthy muscle or muscle-tendon unit from one part of the body to the affected area to restore function.
This procedure is often utilized when the nerve damage is severe and cannot be addressed through nerve grafting or transfer alone.
Muscle transfer aims to improve motor function and strength by using a donor muscle to replace or augment the function of a weakened or paralyzed muscle.
The success of muscle transfer depends on precise surgical technique, the health of the donor muscle, and effective post-operative rehabilitation.
Procedure Steps:
Pre-Operative Consultation:
- Evaluation of muscle function and injury severity
- Discussion of surgical options and expected outcomes
Diagnostic Imaging:
- MRI or CT scans to plan muscle transfer and assess donor site
Surgical Procedure:
- Harvesting of the donor muscle
- Transfer and attachment of the muscle to the target area
- Suturing and adjustment of muscle function
Hospital Stay:
- Recovery and monitoring in the hospital
Post-Operative Medications:
- Medications to manage pain and prevent infection
Rehabilitation:
- Intensive physical therapy to adapt to the new muscle function
Pricing Information:
- Pre-Operative Consultation: Cost: $100 to $250
- MRI Scan: $300 to $600
- CT Scan (if needed): $200 to $500
- Surgical Procedure: Muscle Transfer Surgery: $7,000 to $10,000
- Hospital Stay: Cost per Night: $200 to $500
- Post-Operative Medications: Cost: $100 to $300
- Physical Therapy Sessions: $50 to $150 per session
- Total Rehab Cost: $2,000 to $5,000
Neurolysis
Definition and Details:
Neurolysis is a surgical procedure aimed at relieving nerve compression and restoring function by removing scar tissue or other obstructions from around the nerve.
This procedure is often employed when the brachial plexus nerve is compressed by scar tissue from previous injuries or surgeries.
Neurolysis helps improve nerve function by freeing the nerve from restrictive tissues, allowing it to function more effectively.
The outcome of neurolysis depends on the degree of compression and the precision of the surgical technique.
Procedure Steps:
Pre-Operative Consultation:
- Evaluation of nerve compression and functional assessment
- Planning of the neurolysis procedure
Diagnostic Imaging:
- MRI or CT scans to identify areas of compression
Surgical Procedure:
- Exposure of the affected nerve
- Removal of scar tissue and other obstructions
- Restoration of nerve pathways
Hospital Stay:
- Post-surgical observation and care
Post-Operative Medications:
- Pain management and anti-inflammatory drugs
Rehabilitation:
- Therapy to improve nerve function and prevent atrophy
Pricing Information:
- Pre-Operative Consultation: Cost: $100 to $250
- MRI Scan: $300 to $600
- CT Scan (if necessary): $200 to $500
- Neurolysis Surgery: $4,000 to $6,000
- Hospital Stay: Cost per Night: $200 to $500
- Post-Operative Medications: Cost: $100 to $300
- Physical Therapy Sessions: $50 to $150 per session
- Total Rehab Cost: $1,500 to $3,000
Muscle Reinnervation
Definition and Details:
Muscle reinnervation involves surgically connecting a healthy nerve to a muscle that has lost its nerve supply.
This procedure aims to restore muscle function by enabling the muscle to receive new nerve signals. Muscle reinnervation is often used in cases where muscle function has been lost due to nerve injury, and direct nerve repair or grafting is not feasible.
The procedure requires precise surgical technique to ensure proper nerve-muscle connections and maximize recovery.
Procedure Steps:
Pre-Operative Consultation:
- Assessment of muscle function and nerve damage
- Discussion of surgical approach and expected results
Diagnostic Imaging:
- MRI or CT scans to evaluate muscle and nerve conditions
Surgical Procedure:
- Identification of a donor nerve
- Surgical attachment of the nerve to the target muscle
- Verification of functional connections
Hospital Stay:
- Monitoring and post-surgery care
Post-Operative Medications:
- Pain relief and anti-inflammatory medications
Rehabilitation:
- Therapy to support muscle reinnervation and function
Pricing Information:
- Pre-Operative Consultation: Cost: $100 to $250
- MRI Scan: $300 to $600
- CT Scan (if required): $200 to $500
- Muscle Reinnervation Surgery: $6,000 to $8,000
- Hospital Stay: Cost per Night: $200 to $500
- Post-Operative Medications: Cost: $100 to $300
- Physical Therapy Sessions: $50 to $150 per session
- Total Rehab Cost: $2,000 to $5,000
Tendon Transfer
Definition and Details:
Tendon transfer surgery involves moving a functioning tendon from one part of the body to the affected area to restore movement and function.
This technique is used when nerve damage has led to muscle paralysis or severe weakness, and other repair options are not suitable.
Tendon transfer aims to compensate for lost muscle function by using a healthy tendon to perform similar movements. The success of tendon transfer depends on the precision of the surgery and the rehabilitation process.
Procedure Steps:
Pre-Operative Consultation:
- Evaluation of muscle function and selection of donor tendon
- Planning of the tendon transfer procedure
Diagnostic Imaging:
- MRI or CT scans to assess tendon and muscle conditions
Surgical Procedure:
- Harvesting of the donor tendon
- Attachment of the tendon to the target muscle or joint
- Verification of function and adjustment
Hospital Stay:
- Recovery and observation post-surgery
Post-Operative Medications:
- Pain management and anti-inflammatory drugs
Rehabilitation:
- Therapy to adapt to the new tendon function and improve range of motion
Pricing Information:
- Pre-Operative Consultation: Cost: $100 to $250
- MRI Scan: $300 to $600
- CT Scan (if necessary): $200 to $500
- Tendon Transfer Surgery: $6,500 to $9,000
- Hospital Stay: Cost per Night: $200 to $500
- Post-Operative Medications: Cost: $100 to $300
- Physical Therapy Sessions: $50 to $150 per session
- Total Rehab Cost: $2,000 to $5,000
Bone Grafting
Definition and Details:
Bone grafting is a procedure used to repair or replace damaged bone tissue in the area affected by Brachial Plexus Injury.
This technique involves transplanting bone tissue from another part of the body or using synthetic bone substitutes to facilitate bone healing and integration.
Bone grafting is often necessary when the injury involves bone fractures or joint damage that affects nerve function.
The procedure aims to restore structural integrity and support nerve regeneration by providing a stable environment for healing.
Procedure Steps:
Pre-Operative Consultation:
- Assessment of bone damage and grafting options
- Discussion of surgical approach and recovery expectations
Diagnostic Imaging:
- MRI or CT scans to evaluate bone damage and plan grafting
Surgical Procedure:
- Harvesting of bone graft or preparation of synthetic material
- Placement of the graft in the damaged area
- Securing and stabilization of the graft
Hospital Stay:
- Post-operative monitoring and care
Post-Operative Medications:
- Medications for pain and infection prevention
Rehabilitation:
- Physical therapy to support bone healing and restore function
Pricing Information:
- Pre-Operative Consultation: Cost: $100 to $250
- MRI Scan: $300 to $600
- CT Scan (if needed): $200 to $500
- Bone Grafting Surgery: $5,500 to $8,500
- Hospital Stay: Cost per Night: $200 to $500
- Post-Operative Medications: Cost: $100 to $300
- Physical Therapy Sessions: $50 to $150 per session
- Total Rehab Cost: $2,000 to $5,000
Arthrodesis (Joint Fusion)
Definition and Details:
Arthrodesis, or joint fusion, is a surgical procedure used to stabilize and fuse joints that are damaged due to Brachial Plexus Injury.
This procedure involves the fusion of two or more bones in a joint using bone grafts or synthetic materials.
Arthrodesis aims to alleviate pain, improve joint stability, and restore function by eliminating movement in the damaged joint.
This technique is often used when joint instability or severe damage affects the function of the affected limb.
Procedure Steps:
Pre-Operative Consultation:
- Evaluation of joint damage and suitability for fusion
- Discussion of the procedure and expected outcomes
Diagnostic Imaging:
- MRI or CT scans to assess joint condition and plan the fusion
Surgical Procedure:
- Preparation of the joint surfaces
- Placement of bone grafts or synthetic materials
- Fusion and stabilization of the joint
Hospital Stay:
- Post-surgery care and monitoring
Post-Operative Medications:
- Pain management and anti-inflammatory drugs
Rehabilitation:
- Therapy to support joint function and prevent complications
Pricing Information:
- Pre-Operative Consultation: Cost: $100 to $250
- MRI Scan: $300 to $600
- CT Scan (if required): $200 to $500
- Arthrodesis Surgery: $6,000 to $8,000
- Hospital Stay: Cost per Night: $200 to $500
- Post-Operative Medications: Cost: $100 to $300
- Physical Therapy Sessions: $50 to $150 per session
- Total Rehab Cost: $2,000 to $5,000
Electrodiagnostic Studies
Definition and Details:
Electrodiagnostic studies are a non-surgical method used to assess nerve function and diagnose the extent of nerve damage in Brachial Plexus Injury cases.
These studies include electromyography (EMG) and nerve conduction studies (NCS), which measure electrical activity in muscles and the speed of nerve signals.
Electrodiagnostic studies help determine the type and severity of nerve injury, guide treatment decisions, and monitor progress during rehabilitation.
Although not a treatment, these studies are crucial for accurate diagnosis and planning of subsequent surgical or non-surgical interventions.
Procedure Steps:
Pre-Study Consultation:
- Evaluation of symptoms and discussion of diagnostic tests
Electromyography (EMG):
- Insertion of fine needles into muscles to record electrical activity
Nerve Conduction Studies (NCS):
- Application of electrical impulses to nerves to measure signal speed and strength
Analysis and Reporting:
- Interpretation of results and formulation of a diagnostic report
Pricing Information:
- Pre-Study Consultation: Cost: $100 to $200
- Electromyography (EMG): Cost: $300 to $500
- Nerve Conduction Studies (NCS): Cost: $250 to $450
- Analysis and Reporting: Cost: $100 to $200
Botulinum Toxin Injections
Definition and Details:
Botulinum toxin injections are a non-surgical treatment used to manage muscle spasticity and pain associated with Brachial Plexus Injury.
The toxin works by blocking nerve signals to specific muscles, thereby reducing spasticity and improving muscle function.
This treatment is typically used as an adjunct to other therapies or when surgery is not feasible. Botulinum toxin injections offer temporary relief and are usually repeated every few months to maintain effectiveness.
Procedure Steps:
Pre-Treatment Consultation:
- Evaluation of muscle spasticity and suitability for botulinum toxin
Injection Procedure:
- Injection of botulinum toxin into targeted muscles using fine needles
Post-Treatment Monitoring:
- Observation of effects and assessment of any side effects
Pricing Information:
- Pre-Treatment Consultation: Cost: $100 to $200
- Injection Procedure: Cost per Injection Session: $500 to $1,000
- Post-Treatment Monitoring: Cost: $100 to $200
Prices of the Brachial Plexus Injury in the major cities in Turkey.
Nerve Grafting
Istanbul:
- Pre-Operative Consultation: $120 to $250
- Second Opinion Consultation: $100 to $200
- Full Medical Evaluation: $150 to $300
- MRI Scan: $350 to $600
- CT Scan: $250 to $500
- Nerve Grafting Surgery: $6,500 to $8,500
- Anesthesia Costs: $800 to $1,200
- Hospital Stay (per night): $250 to $550
- Post-Operative Medications: $120 to $300
- Rehabilitation (total): $2,500 to $5,500
Ankara:
- Pre-Operative Consultation: $100 to $225
- Second Opinion Consultation: $90 to $190
- Full Medical Evaluation: $130 to $270
- MRI Scan: $300 to $550
- CT Scan: $200 to $450
- Nerve Grafting Surgery: $6,000 to $8,000
- Anesthesia Costs: $700 to $1,100
- Hospital Stay (per night): $200 to $500
- Post-Operative Medications: $100 to $275
- Rehabilitation (total): $2,000 to $5,000
Izmir:
- Pre-Operative Consultation: $110 to $240
- Second Opinion Consultation: $95 to $210
- Full Medical Evaluation: $140 to $290
- MRI Scan: $320 to $580
- CT Scan: $220 to $470
- Nerve Grafting Surgery: $6,200 to $8,200
- Anesthesia Costs: $750 to $1,150
- Hospital Stay (per night): $230 to $530
- Post-Operative Medications: $130 to $290
- Rehabilitation (total): $2,300 to $5,300
Nerve Transfer
Istanbul:
- Pre-Operative Consultation: $130 to $260
- Second Opinion Consultation: $110 to $220
- Full Medical Evaluation: $160 to $310
- MRI Scan: $360 to $620
- CT Scan: $260 to $510
- Nerve Transfer Surgery: $6,800 to $8,800
- Anesthesia Costs: $850 to $1,250
- Hospital Stay (per night): $270 to $570
- Post-Operative Medications: $130 to $320
- Rehabilitation (total): $2,600 to $5,700
Ankara:
- Pre-Operative Consultation: $110 to $230
- Second Opinion Consultation: $100 to $200
- Full Medical Evaluation: $140 to $280
- MRI Scan: $310 to $560
- CT Scan: $210 to $460
- Nerve Transfer Surgery: $6,200 to $8,200
- Anesthesia Costs: $750 to $1,150
- Hospital Stay (per night): $220 to $510
- Post-Operative Medications: $110 to $290
- Rehabilitation (total): $2,300 to $5,400
Izmir:
- Pre-Operative Consultation: $120 to $250
- Second Opinion Consultation: $100 to $210
- Full Medical Evaluation: $150 to $300
- MRI Scan: $330 to $590
- CT Scan: $230 to $480
- Nerve Transfer Surgery: $6,400 to $8,400
- Anesthesia Costs: $800 to $1,200
- Hospital Stay (per night): $240 to $550
- Post-Operative Medications: $140 to $300
- Rehabilitation (total): $2,400 to $5,500
Tendon Transfer
Istanbul:
- Pre-Operative Consultation: $140 to $270
- Second Opinion Consultation: $120 to $230
- Full Medical Evaluation: $170 to $320
- MRI Scan: $370 to $640
- CT Scan: $270 to $520
- Tendon Transfer Surgery: $7,000 to $9,000
- Anesthesia Costs: $900 to $1,300
- Hospital Stay (per night): $280 to $590
- Post-Operative Medications: $140 to $330
- Rehabilitation (total): $2,700 to $5,800
Ankara:
- Pre-Operative Consultation: $120 to $240
- Second Opinion Consultation: $110 to $220
- Full Medical Evaluation: $150 to $290
- MRI Scan: $320 to $570
- CT Scan: $220 to $470
- Tendon Transfer Surgery: $6,500 to $8,500
- Anesthesia Costs: $800 to $1,200
- Hospital Stay (per night): $240 to $520
- Post-Operative Medications: $120 to $300
- Rehabilitation (total): $2,400 to $5,500
Izmir:
- Pre-Operative Consultation: $130 to $260
- Second Opinion Consultation: $110 to $220
- Full Medical Evaluation: $160 to $310
- MRI Scan: $340 to $600
- CT Scan: $240 to $490
- Tendon Transfer Surgery: $6,600 to $8,600
- Anesthesia Costs: $850 to $1,250
- Hospital Stay (per night): $250 to $560
- Post-Operative Medications: $150 to $310
- Rehabilitation (total): $2,500 to $5,600
Muscle Transfer
Istanbul:
- Pre-Operative Consultation: $150 to $280
- Second Opinion Consultation: $130 to $240
- Full Medical Evaluation: $180 to $330
- MRI Scan: $380 to $660
- CT Scan: $280 to $530
- Muscle Transfer Surgery: $7,200 to $9,200
- Anesthesia Costs: $950 to $1,350
- Hospital Stay (per night): $290 to $600
- Post-Operative Medications: $150 to $340
- Rehabilitation (total): $2,800 to $5,900
Ankara:
- Pre-Operative Consultation: $130 to $250
- Second Opinion Consultation: $120 to $230
- Full Medical Evaluation: $160 to $300
- MRI Scan: $330 to $580
- CT Scan: $230 to $480
- Muscle Transfer Surgery: $6,800 to $8,800
- Anesthesia Costs: $850 to $1,250
- Hospital Stay (per night): $250 to $530
- Post-Operative Medications: $130 to $310
- Rehabilitation (total): $2,500 to $5,700
Izmir:
- Pre-Operative Consultation: $140 to $270
- Second Opinion Consultation: $120 to $230
- Full Medical Evaluation: $170 to $320
- MRI Scan: $350 to $610
- CT Scan: $250 to $490
- Muscle Transfer Surgery: $6,900 to $8,900
- Anesthesia Costs: $900 to $1,300
- Hospital Stay (per night): $260 to $570
- Post-Operative Medications: $160 to $320
- Rehabilitation (total): $2,600 to $5,800
Tendon Repair
Istanbul:
- Pre-Operative Consultation: $160 to $290
- Second Opinion Consultation: $140 to $250
- Full Medical Evaluation: $190 to $340
- MRI Scan: $390 to $680
- CT Scan: $290 to $540
- Tendon Repair Surgery: $7,500 to $9,500
- Anesthesia Costs: $1,000 to $1,400
- Hospital Stay (per night): $300 to $620
- Post-Operative Medications: $160 to $350
- Rehabilitation (total): $2,900 to $6,000
Ankara:
- Pre-Operative Consultation: $140 to $260
- Second Opinion Consultation: $130 to $240
- Full Medical Evaluation: $170 to $310
- MRI Scan: $340 to $590
- CT Scan: $240 to $490
- Tendon Repair Surgery: $7,000 to $9,000
- Anesthesia Costs: $900 to $1,300
- Hospital Stay (per night): $260 to $540
- Post-Operative Medications: $140 to $320
- Rehabilitation (total): $2,600 to $5,800
Izmir:
- Pre-Operative Consultation: $150 to $280
- Second Opinion Consultation: $130 to $240
- Full Medical Evaluation: $180 to $330
- MRI Scan: $360 to $620
- CT Scan: $250 to $500
- Tendon Repair Surgery: $7,100 to $9,100
- Anesthesia Costs: $950 to $1,350
- Hospital Stay (per night): $270 to $580
- Post-Operative Medications: $170 to $330
- Rehabilitation (total): $2,700 to $5,900
Joint Replacement
Istanbul:
- Pre-Operative Consultation: $170 to $300
- Second Opinion Consultation: $150 to $260
- Full Medical Evaluation: $200 to $350
- MRI Scan: $400 to $700
- CT Scan: $300 to $550
- Joint Replacement Surgery: $8,000 to $10,000
- Anesthesia Costs: $1,100 to $1,500
- Hospital Stay (per night): $320 to $640
- Post-Operative Medications: $170 to $360
- Rehabilitation (total): $3,000 to $6,200
Ankara:
- Pre-Operative Consultation: $150 to $270
- Second Opinion Consultation: $140 to $250
- Full Medical Evaluation: $180 to $320
- MRI Scan: $350 to $600
- CT Scan: $250 to $500
- Joint Replacement Surgery: $7,500 to $9,500
- Anesthesia Costs: $1,000 to $1,400
- Hospital Stay (per night): $280 to $560
- Post-Operative Medications: $150 to $340
- Rehabilitation (total): $2,800 to $6,000
Izmir:
- Pre-Operative Consultation: $160 to $290
- Second Opinion Consultation: $140 to $250
- Full Medical Evaluation: $190 to $340
- MRI Scan: $370 to $630
- CT Scan: $260 to $510
- Joint Replacement Surgery: $7,800 to $9,800
- Anesthesia Costs: $1,050 to $1,400
- Hospital Stay (per night): $290 to $590
- Post-Operative Medications: $180 to $350
- Rehabilitation (total): $2,900 to $6,100
Skin Grafting
Istanbul:
- Pre-Operative Consultation: $180 to $310
- Second Opinion Consultation: $160 to $270
- Full Medical Evaluation: $210 to $360
- MRI Scan: $410 to $720
- CT Scan: $310 to $560
- Skin Grafting Surgery: $7,500 to $9,500
- Anesthesia Costs: $1,100 to $1,500
- Hospital Stay (per night): $330 to $650
- Post-Operative Medications: $180 to $370
- Rehabilitation (total): $3,100 to $6,300
Ankara:
- Pre-Operative Consultation: $160 to $280
- Second Opinion Consultation: $150 to $260
- Full Medical Evaluation: $190 to $330
- MRI Scan: $360 to $610
- CT Scan: $260 to $510
- Skin Grafting Surgery: $7,000 to $9,000
- Anesthesia Costs: $1,000 to $1,400
- Hospital Stay (per night): $290 to $570
- Post-Operative Medications: $160 to $350
- Rehabilitation (total): $2,900 to $6,100
Izmir:
- Pre-Operative Consultation: $170 to $300
- Second Opinion Consultation: $150 to $260
- Full Medical Evaluation: $200 to $350
- MRI Scan: $380 to $640
- CT Scan: $270 to $520
- Skin Grafting Surgery: $7,600 to $9,600
- Anesthesia Costs: $1,050 to $1,400
- Hospital Stay (per night): $300 to $600
- Post-Operative Medications: $190 to $360
- Rehabilitation (total): $3,000 to $6,200
Microsurgical Repair
Istanbul:
- Pre-Operative Consultation: $190 to $320
- Second Opinion Consultation: $170 to $280
- Full Medical Evaluation: $220 to $370
- MRI Scan: $420 to $740
- CT Scan: $320 to $570
- Microsurgical Repair Surgery: $8,000 to $10,000
- Anesthesia Costs: $1,200 to $1,600
- Hospital Stay (per night): $340 to $660
- Post-Operative Medications: $190 to $380
- Rehabilitation (total): $3,200 to $6,400
Ankara:
- Pre-Operative Consultation: $170 to $290
- Second Opinion Consultation: $160 to $270
- Full Medical Evaluation: $200 to $340
- MRI Scan: $370 to $620
- CT Scan: $270 to $520
- Microsurgical Repair Surgery: $7,500 to $9,500
- Anesthesia Costs: $1,100 to $1,500
- Hospital Stay (per night): $300 to $580
- Post-Operative Medications: $170 to $360
- Rehabilitation (total): $3,000 to $6,300
Izmir:
- Pre-Operative Consultation: $180 to $310
- Second Opinion Consultation: $160 to $270
- Full Medical Evaluation: $210 to $360
- MRI Scan: $390 to $650
- CT Scan: $280 to $530
- Microsurgical Repair Surgery: $8,100 to $10,100
- Anesthesia Costs: $1,150 to $1,500
- Hospital Stay (per night): $310 to $610
- Post-Operative Medications: $200 to $370
- Rehabilitation (total): $3,100 to $6,400
Orthotic Fitting
Istanbul:
- Pre-Operative Consultation: $200 to $330
- Second Opinion Consultation: $180 to $290
- Full Medical Evaluation: $230 to $380
- MRI Scan: $430 to $760
- CT Scan: $330 to $580
- Orthotic Fitting Procedure: $8,200 to $10,200
- Anesthesia Costs: $1,250 to $1,700
- Hospital Stay (per night): $350 to $670
- Post-Operative Medications: $200 to $390
- Rehabilitation (total): $3,300 to $6,500
Ankara:
- Pre-Operative Consultation: $180 to $300
- Second Opinion Consultation: $170 to $280
- Full Medical Evaluation: $210 to $350
- MRI Scan: $380 to $630
- CT Scan: $280 to $540
- Orthotic Fitting Procedure: $7,800 to $9,800
- Anesthesia Costs: $1,150 to $1,550
- Hospital Stay (per night): $310 to $590
- Post-Operative Medications: $180 to $370
- Rehabilitation (total): $3,100 to $6,400
Izmir:
- Pre-Operative Consultation: $190 to $320
- Second Opinion Consultation: $170 to $280
- Full Medical Evaluation: $220 to $370
- MRI Scan: $400 to $660
- CT Scan: $290 to $550
- Orthotic Fitting Procedure: $8,000 to $10,000
- Anesthesia Costs: $1,200 to $1,550
- Hospital Stay (per night): $320 to $620
- Post-Operative Medications: $190 to $380
- Rehabilitation (total): $3,200 to $6,500
Bone Fusion
Istanbul:
- Pre-Operative Consultation: $210 to $340
- Second Opinion Consultation: $190 to $300
- Full Medical Evaluation: $240 to $390
- MRI Scan: $440 to $780
- CT Scan: $340 to $590
- Bone Fusion Surgery: $8,500 to $10,500
- Anesthesia Costs: $1,300 to $1,700
- Hospital Stay (per night): $360 to $690
- Post-Operative Medications: $210 to $400
- Rehabilitation (total): $3,400 to $6,700
Ankara:
- Pre-Operative Consultation: $190 to $310
- Second Opinion Consultation: $180 to $290
- Full Medical Evaluation: $220 to $370
- MRI Scan: $390 to $640
- CT Scan: $290 to $550
- Bone Fusion Surgery: $8,000 to $10,000
- Anesthesia Costs: $1,200 to $1,600
- Hospital Stay (per night): $320 to $600
- Post-Operative Medications: $190 to $380
- Rehabilitation (total): $3,200 to $6,500
Izmir:
- Pre-Operative Consultation: $200 to $330
- Second Opinion Consultation: $180 to $290
- Full Medical Evaluation: $230 to $380
- MRI Scan: $410 to $670
- CT Scan: $300 to $560
- Bone Fusion Surgery: $8,600 to $10,600
- Anesthesia Costs: $1,250 to $1,600
- Hospital Stay (per night): $330 to $630
- Post-Operative Medications: $200 to $390
- Rehabilitation (total): $3,300 to $6,600
Why Choose Turkey for Brachial Plexus Injury Treatment?
Turkey has emerged as a leading destination for medical tourism, offering a range of benefits for patients seeking Brachial Plexus Injury treatment:
High Standards of Care:
Turkish hospitals and clinics adhere to international standards of medical care. Many facilities are accredited by prestigious organizations such as the Joint Commission International (JCI), ensuring high-quality treatment and patient safety.
Experienced Surgeons:
Turkey boasts a large pool of highly skilled surgeons specializing in complex procedures such as Brachial Plexus Injury treatment.
Many of these specialists have received training and certification from leading international institutions.
Cost-Effectiveness:
The overall cost of treatment in Turkey is often significantly lower than in Western countries, without compromising on the quality of care.
Patients can benefit from affordable treatment options while receiving world-class medical services.
Comprehensive Medical Tourism Services:
Turkish hospitals frequently offer comprehensive medical tourism services, including assistance with travel arrangements, accommodation, and language support.
These services make the process of seeking treatment abroad more convenient and accessible for international patients.
Advanced Medical Technology:
Turkish medical facilities are equipped with state-of-the-art technology and advanced surgical techniques.
This enables them to provide effective treatment options and achieve favorable outcomes for patients with Brachial Plexus Injury.
How to prepare for a Brachial Plexus Injury procedure?
Personal Preparations
Understand the Procedure and Recovery:
- Description: Gaining a deep understanding of the Brachial Plexus Injury procedure is crucial. This includes comprehending the surgical techniques, the expected results, and the recovery process. Knowledge about the procedure will help set realistic expectations and prepare you mentally.
How to Prepare:
- Research: Read comprehensive articles and medical literature about the procedure.
- Patient Stories: Engage with patient forums and read personal stories to understand different experiences.
- Consultations: Attend educational seminars or webinars hosted by medical professionals.
Pre-Operative Health Assessment:
- Description: A thorough health assessment ensures that you are in good physical condition for the surgery. This involves reviewing your overall health, current medical conditions, and any potential risks that could impact the procedure or recovery.
How to Prepare:
- Medical History: Gather detailed information about your past health issues, surgeries, and ongoing treatments.
- Physical Exam: Schedule a comprehensive physical examination with your primary care physician.
- Tests and Labs: Complete any required laboratory tests, such as blood work, and provide results to your surgeon.
Lifestyle Modifications:
- Description: Making positive lifestyle changes can enhance your health and speed up recovery. This includes dietary adjustments, increased physical activity, and eliminating harmful habits.
How to Prepare:
- Diet: Adopt a diet rich in essential nutrients, focusing on proteins, vitamins, and minerals that aid in healing.
- Exercise: Engage in regular, moderate exercise to improve cardiovascular health and overall fitness.
- Habits: Quit smoking and reduce alcohol consumption as they can impede healing and increase the risk of complications.
Financial Planning:
- Description: Understanding and managing the financial aspects of the procedure is crucial. This involves budgeting for the surgery, additional costs, and ensuring that you have sufficient funds or insurance coverage.
How to Prepare:
- Cost Breakdown: Review detailed cost estimates provided by your healthcare provider.
- Insurance: Verify your insurance coverage and understand what is included.
- Financing Options: Explore options for financing if necessary, including payment plans or loans.
Arrange Post-Operative Care:
- Description: Planning for care immediately after the surgery is essential. This includes arranging for help with daily activities, transportation, and follow-up care.
How to Prepare:
- Caregiver: Identify a family member or friend who can assist you with daily tasks and transportation.
- Follow-Up: Schedule follow-up appointments with your healthcare provider.
- Support Systems: Organize any necessary home support, such as a nurse or therapist, if recommended.
Prepare Your Home Environment:
- Description: Adjusting your living space can create a more comfortable and safe recovery environment. This includes removing potential hazards and ensuring that your home meets all your post-operative needs.
How to Prepare:
- Safety Checks: Remove any obstacles that could cause falls or injuries.
- Comfort Setup: Arrange a comfortable recovery area with easy access to necessities.
- Medical Supplies: Stock up on essential items such as medications, wound care supplies, and mobility aids.
Mental and Emotional Readiness:
- Description: Mental preparation is as important as physical preparation. Addressing any anxiety or stress can improve your overall experience and recovery.
How to Prepare:
- Stress Management: Practice relaxation techniques such as mindfulness, meditation, or yoga.
- Support Networks: Engage with support groups or counseling services if needed.
- Positive Visualization: Visualize a successful outcome and recovery to enhance mental preparedness.
Medication Management:
- Description: Proper management of medications is crucial to avoid interactions or complications during and after the surgery. This includes reviewing current medications and adjusting as necessary.
How to Prepare:
- Medication List: Compile a detailed list of all medications, including prescriptions, over-the-counter drugs, and supplements.
- Consultation: Discuss this list with your surgeon and follow their instructions on what to take or stop before the procedure.
- Refills: Ensure that you have enough of any prescribed medications for post-operative care.
Pre-Operative Fasting and Dietary Instructions:
- Description: Following specific fasting and dietary instructions is essential to ensure that you are properly prepared for anesthesia and surgery.
How to Prepare:
- Fasting Guidelines: Adhere to fasting instructions provided by your surgeon, typically starting from the night before the surgery.
- Dietary Adjustments: Follow any dietary recommendations, such as avoiding certain foods or drinks, to prepare your body for the procedure.
Plan for Post-Operative Rehabilitation:
- Description: Understanding and preparing for the rehabilitation process is key to a successful recovery. This includes knowing the type of therapy required and scheduling sessions in advance.
How to Prepare:
- Rehabilitation Plan: Discuss the rehabilitation process with your surgeon and physical therapist.
- Scheduling: Arrange therapy appointments and any required home exercises.
- Commitment: Prepare to adhere to the rehabilitation plan diligently to achieve the best recovery outcomes.
Preparations with the Doctor
Initial Consultation and Evaluation:
- Description: The initial consultation involves a thorough evaluation of your condition, discussing the surgical approach, and setting clear expectations. This meeting is crucial for understanding the procedure and planning.
How to Prepare:
- Medical Records: Bring all relevant medical records and previous test results.
- Questions: Prepare a list of questions about the procedure, risks, benefits, and recovery.
- Expectations: Clearly communicate your goals and concerns with your surgeon.
Detailed Surgical Plan:
- Description: Work with your surgeon to develop a detailed surgical plan, including the specific techniques and approaches to be used. This plan will guide the procedure and help manage expectations.
How to Prepare:
- Technique Review: Discuss the different surgical techniques and their potential outcomes.
- Risk Assessment: Understand the risks associated with each technique and how they will be managed.
- Customized Plan: Ensure that the plan is tailored to your specific condition and needs.
Pre-Operative Testing and Imaging:
- Description: Completing pre-operative tests and imaging is essential to assess the severity of your injury and to plan the surgery effectively. This may include MRIs, CT scans, and other diagnostic tests.
How to Prepare:
- Scheduling: Schedule all required tests and imaging appointments as advised by your surgeon.
- Preparation: Follow any specific instructions for preparing for these tests, such as fasting or avoiding certain medications.
- Results: Ensure that all results are reviewed by your surgeon before the procedure.
Anesthesia Consultation:
- Description: A consultation with the anesthesiologist is necessary to discuss the type of anesthesia that will be used, along with any associated risks and preparation required.
How to Prepare:
- Anesthesia History: Provide a history of any previous experiences with anesthesia, including any adverse reactions.
- Concerns: Discuss any concerns or preferences regarding anesthesia with the anesthesiologist.
- Pre-Surgery Instructions: Follow any instructions regarding medications or fasting before the anesthesia.
Pre-Surgery Medications and Instructions:
- Description: Follow the surgeon’s instructions regarding any medications to take or avoid before the surgery. This helps in minimizing risks and ensuring a smooth procedure.
How to Prepare:
- Medication Review: Review all medications with your surgeon, including over-the-counter drugs and supplements.
- Adjustments: Make any necessary adjustments to your medication regimen as advised.
- Instructions: Follow all provided instructions regarding medication use or discontinuation.
Consent and Documentation:
- Description: Review and sign all necessary consent forms and documentation related to the surgery. This includes understanding the risks, benefits, and alternatives to the procedure.
How to Prepare:
- Form Review: Carefully read all consent forms and documentation.
- Clarifications: Seek clarification on any points that are unclear or concerning.
- Signature: Ensure that all required forms are signed and submitted before the surgery.
Discuss Post-Operative Care Plan:
- Description: Understanding the post-operative care plan is essential for a successful recovery. This plan will include follow-up appointments, rehabilitation, and any necessary lifestyle changes.
How to Prepare:
- Care Instructions: Review detailed instructions for post-operative care, including wound care and activity restrictions.
- Follow-Up: Schedule follow-up appointments and ensure that you understand the importance of attending them.
- Lifestyle Changes: Discuss any recommended lifestyle changes and how they will support your recovery.
Coordinate with Healthcare Providers:
- Description: Ensure that all healthcare providers involved in your care are coordinated and informed about the procedure and recovery plan.
How to Prepare:
- Communication: Share information about the surgery with your primary care physician and any other relevant healthcare providers.
- Records: Ensure that your medical records are up-to-date and accessible to all involved providers.
- Collaborative Care: Coordinate any additional treatments or therapies that may be required.
Emergency Plan:
- Description: Establishing an emergency plan is crucial for managing any unexpected complications or issues that may arise during or after the surgery.
How to Prepare:
- Complication Awareness: Discuss potential complications with your surgeon and understand the signs to watch for.
- Emergency Contacts: Prepare a list of emergency contacts and ensure that your caregiver is informed.
- Action Plan: Develop a plan for addressing any issues, including whom to contact and where to seek help.
Pre-Operative Checklists and Reminders:
- Description: Follow any pre-operative checklists and reminders provided by your surgical team to ensure that all necessary preparations are completed before the procedure.
How to Prepare:
- Checklist Review: Review and complete all items on the pre-operative checklist.
- Reminders: Set reminders for important tasks and appointments leading up to the surgery.
- Final Confirmation: Confirm all arrangements and preparations with your surgical team.
What happens during a Brachial Plexus Injury Procedure?
Preoperative Preparation
Overview: The preoperative preparation phase ensures that everything is in place for a safe and effective surgery.
This phase involves preparing the patient both physically and mentally, as well as making necessary logistical arrangements.
What the Doctor Does:
- Patient Positioning: Places the patient on the operating table in a position that provides optimal access to the brachial plexus. This usually involves placing the patient either in a supine position (lying on their back) or in a semi-prone position (partially on their side), depending on the surgical approach.
- Anesthesia Administration: Administers general anesthesia to induce unconsciousness or a regional anesthesia (e.g., brachial plexus block) to numb the arm and shoulder area. This step ensures that the patient will not experience pain during the surgery.
- Monitoring Setup: Connects the patient to various monitoring devices to track vital signs such as heart rate, blood pressure, respiratory rate, and oxygen saturation. This continuous monitoring helps in early detection of any complications.
Preparation Steps:
- Fasting Instructions: The patient must fast for a certain period before the surgery to reduce the risk of complications from anesthesia.
- Medication Review: The doctor reviews the patient’s current medications and may advise on adjustments or discontinuation of certain drugs.
- Consent Form: The patient signs an informed consent form, acknowledging understanding of the procedure, risks, and benefits.
Incision and Exposure
Overview: This step involves making an incision to access the damaged nerves. It requires precise and careful dissection to avoid injury to surrounding tissues and to adequately expose the brachial plexus.
What the Doctor Does:
- Incision Creation: Makes a carefully planned incision over the targeted area, which could be the shoulder, neck, or upper chest, depending on the specific injury and surgical approach.
- Dissection of Tissues: Methodically dissects through the layers of skin, fat, and muscle to reach the brachial plexus. This is done with meticulous care to minimize damage to surrounding structures.
- Control of Bleeding: Uses electrocautery or other hemostatic techniques to control any bleeding and to maintain a clear view of the surgical field.
Incision Steps:
- Marking the Incision Site: Marks the incision site based on preoperative imaging and surgical planning.
- Initial Incision: Makes the initial cut through the skin and subcutaneous tissues.
- Layered Dissection: Dissects through deeper layers, including muscle and fascia, using retractors to hold the incision open and provide better visibility.
Nerve Identification
Overview: Identifying and isolating the damaged nerves is crucial for determining the appropriate repair strategy. This step involves precise work to differentiate between healthy and damaged nerves.
What the Doctor Does:
- Anatomical Identification: Uses anatomical landmarks and surgical maps to identify the brachial plexus nerves accurately. This may involve intraoperative nerve stimulation or mapping techniques.
- Isolation of Nerves: Carefully separates the damaged nerves from surrounding tissues and nerves to prepare them for repair or reconstruction.
- Assessment of Damage: Evaluates the extent of nerve damage to decide on the most suitable repair technique, whether it be direct suturing, grafting, or nerve transfer.
Identification Steps:
- Nerve Stimulation: Applies mild electrical stimulation to identify and confirm the affected nerves.
- Dissection Around Nerves: Gently dissects around the identified nerves to ensure clear access for repair.
- Damage Assessment: Assesses the quality and degree of nerve damage, including any presence of scar tissue or necrosis.
Nerve Repair or Reconstruction
Overview: This step involves the primary surgical intervention to repair or reconstruct the damaged nerves. The approach depends on the type and extent of the nerve injury.
What the Doctor Does:
- Direct Nerve Repair: If possible, directly sutures the ends of the damaged nerve together. This involves aligning the nerve ends precisely to facilitate healing.
- Nerve Grafting: If direct repair is not feasible, uses nerve grafts (taken from other parts of the body) to bridge the gap between the nerve ends. The choice of graft material (e.g., sural nerve grafts) is based on the injury’s characteristics.
- Nerve Transfer: Performs nerve transfer procedures where a functioning nerve is rerouted to restore function to the affected area. This technique is used when direct repair or grafting is insufficient.
Repair Steps:
- Preparation of Nerve Ends: Prepares the nerve ends by removing any scar tissue and aligning the ends for repair.
- Suturing: Uses microsurgical techniques to suture the nerve ends or grafts in place.
- Fixation: Secures the grafts or repaired nerves using sutures or other fixation methods to maintain alignment and stability.
Nerve Stabilization
Overview: After repairing or reconstructing the nerves, stabilization ensures that the nerves remain in the correct position during the healing process.
What the Doctor Does:
- Stabilization Techniques: Uses sutures, tissue adhesives, or synthetic materials to stabilize the repaired nerves and prevent movement or tension.
- Additional Support: May use surrounding tissues or placement of biologic materials to provide extra support and enhance stability.
- Continuous Assessment: Regularly assesses the stability of the nerves throughout the stabilization phase to ensure they remain properly aligned.
Stabilization Steps:
- Securing Nerves: Fixes the nerves using sutures or fixation devices.
- Tissue Reinforcement: Adds support with adjacent tissues or synthetic materials if required.
- Checking Alignment: Continuously checks the alignment and stability of the nerves during the stabilization phase.
Wound Closure
Overview: Closing the incision properly is crucial for healing and reducing the risk of infection. This step involves carefully suturing the incision site.
What the Doctor Does:
- Layered Closure: Closes the incision in layers, starting with deeper tissues such as fascia and muscle, and ending with the skin. This method reduces tension on the skin and promotes better healing.
- Drain Placement: If necessary, places a drain to prevent fluid accumulation and reduce the risk of seroma or hematoma formation.
- Dressing Application: Applies sterile dressings or bandages over the incision site to protect it and support initial healing.
Closure Steps:
- Deeper Layer Suturing: Sutures the deeper layers of the incision to support internal healing.
- Skin Closure: Uses sutures, staples, or adhesive strips to close the skin layer.
- Drain Insertion: Places a drain if needed to manage excess fluid.
- Applying Dressings: Applies sterile dressings to cover the wound and secure the site.
Postoperative Monitoring
Overview: This phase involves monitoring the patient immediately after surgery to detect any potential complications and manage initial recovery.
What the Doctor Does:
- Vital Signs Monitoring: Continuously monitors vital signs such as heart rate, blood pressure, and oxygen levels to detect any immediate postoperative issues.
- Pain Management: Administers pain relief medications and adjusts dosages based on the patient’s pain levels and response.
- Initial Assessment: Conducts a thorough initial assessment of the surgical site and overall condition to ensure there are no immediate complications.
Monitoring Steps:
- Checking Vital Signs: Regularly monitors vital signs in the recovery room.
- Pain Control: Manages pain with medications and monitors effectiveness.
- Site Inspection: Inspects the surgical site for any signs of complications or issues.
Early Postoperative Care
Overview: During the early postoperative period, the focus is on managing the patient’s immediate recovery needs and transitioning to home or rehabilitation care.
What the Doctor Does:
- Care Instructions: Provides detailed instructions for wound care, activity restrictions, and signs of potential complications. This includes guidance on how to care for the incision site and when to seek medical help.
- Rehabilitation Planning: Begins planning for the rehabilitation phase, including scheduling physical therapy and follow-up appointments.
- Follow-Up Scheduling: Schedules follow-up visits to monitor recovery progress and address any concerns.
Early Care Steps:
- Instructions for Home Care: Provides written and verbal instructions for managing the surgical site at home.
- Rehabilitation Coordination: Coordinates with rehabilitation specialists to outline the recovery plan.
- Follow-Up Appointments: Arranges and confirms follow-up appointments to monitor the recovery process.
Rehabilitation and Physical Therapy
Overview: Early rehabilitation and physical therapy are critical for restoring function and optimizing recovery after the procedure.
What the Doctor Does:
- Setting Goals: Sets specific goals for rehabilitation based on the extent of the nerve injury and the surgical intervention performed.
- Referrals: Refers the patient to physical therapy or occupational therapy specialists to begin the rehabilitation process.
- Progress Monitoring: Regularly monitors the patient’s progress in therapy and adjusts the rehabilitation plan as needed to enhance recovery.
Rehabilitation Steps:
- Rehabilitation Planning: Develops a personalized rehabilitation plan outlining therapy goals and exercises.
- Referral to Specialists: Refers the patient to physical or occupational therapists.
- Progress Evaluation: Evaluates progress and adjusts the rehabilitation plan based on the patient’s response to therapy.
Long-Term Follow-Up
Overview: Long-term follow-up involves ongoing care to ensure that the nerve repair is successful and that the patient achieves the best possible functional recovery.
What the Doctor Does:
- Regular Follow-Ups: Conducts regular follow-up visits to assess the long-term outcomes of the surgery, monitor for complications, and evaluate functional recovery.
- Functional Assessment: Performs assessments to evaluate the recovery of motor and sensory functions in the affected arm and adjusts the treatment plan as necessary.
- Ongoing Support: Provides continued support and guidance, including additional therapies or interventions if needed.
Follow-Up Steps:
- Scheduled Visits: Schedules regular follow-up visits to monitor recovery and address any issues.
- Functional Testing: Conducts tests to evaluate the function of the affected arm and hand.
- Support and Guidance: Offers ongoing support and adjusts treatment plans based on recovery progress.
Conclusion
The cost of treating Brachial Plexus Injury in Turkey encompasses a variety of factors, including surgical procedures, diagnostic tests, hospital stays, rehabilitation, and follow-up care.
On average, patients can expect to spend between $8,000 and $20,000 for comprehensive treatment, depending on the specific needs and choices of the patient.
Turkey offers a compelling option for those seeking high-quality, cost-effective medical care, with numerous experienced specialists and advanced facilities available.