The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies.

A 61-year-old man presented to his general practitioner (GP) with a 6-month history of an asymptomatic cutaneous lesion to the upper left side-wall of his nose. He was otherwise well and was taking no medication. Physical examination demonstrated a 5-Â 5-mm firm red cystic lesion. There was no evidence of regional metastases.The GP performed a biopsy using sharp ring curettage. Histology of the lesion demonstrated a sebaceous carcinoma (SC) (Figure 1). The subject was subsequently referred to our service.A literature review revealed the potential metastatic nature of extraocular SC. After discussion at our multidisciplinary team meeting, it was concluded that wide local excision with a 4-mm margin should be performed in combination with sentinel lymph node biopsy.The lymphoscintigraphy technique was used with technetium Tc-99m sulfur colloid and patent blue dye injected around the site of the original excision. Three level II (upper jugular group) nodes were localized using a radiation counter and direct visualization. These were excised. Lymphoscintigraphy images are shown in Figure 2.Wide local excision with a 4-mm margin was performed and the defect resurfaced with a fullthickness skin graft. Histology of the wide local excision showed no evidence of malignancy, and sentinel node biopsy from the left neck showed no evidence of metastatic disease. Three years after sentinel node biopsy, the subject had no evidence of any local or regional reoccurrence.We present the articles that have reported the metastatic nature of extraocular SC and report to the best of our knowledge the first extraocular SC sentinel node biopsy. We therefore advocate the benefit of sentinel node biopsy for these tumors.

Preferred music in the OR may have a positive effect on trainees' microsurgical performance; as such, trainees should be encouraged to participate in setting the conditions of the OR to optimize their comfort and, possibly, performance. Moreover, motion analysis technology is a useful tool with a wide range of applications for surgical education and outcomes optimization.

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LVH (left ventricular hypertrophy) is associated with impaired coronary vascular reserve. In the present study, we examined the effect of pressure-overload hypertrophy on vasorelaxant responses of guinea-pig isolated coronary small arteries and compared them with mesenteric small arteries. Pressure-overload was induced by banding the ascending aorta of guinea-pigs. Haemodynamics, and ventricular, atrial and lung weights were measured 168 days after banding. Isolated coronary and mesenteric small arteries were contracted with a thromboxane mimetic (U46619) and relaxation to ACH (acetylcholine), ISO (isoprenaline), FSK (forskolin) and SNP (sodium nitroprusside) was examined. Arterial wall morphology was examined by light microscopy. Aortic banding reduced cardiac output and increased systemic vascular resistance; atrial, ventricular and lung weights were increased. Coronary artery adventitial and medial thickness were increased, but mesenteric arterial wall morphology was unaffected. Coronary artery relaxation to ACH, ISO, FSK and SNP were reduced in banded animals. In contrast, relaxation of mesenteric arteries to ACH, FSK and SNP were unaffected by banding, although ISO-induced relaxation was reduced. A COX (cyclo-oxygenase) inhibitor, indomethacin, had no effect on coronary artery responses to ACH in banded or sham animals, but the differences in relaxation of coronary arteries between banded and sham animals were no longer significant following pre-incubation with the NO inhibitors L-NMMA (N(G)-monomethyl-L-arginine) and oxyhaemoglobin. In conclusion, pressure-overload-induced LVH causes impaired relaxation of small coronary arteries to endothelium-dependent and -independent relaxants. These findings are indicative of alterations in vascular smooth muscle responsiveness to vasodilators. Impairment of coronary arterial vasodilation may contribute to the reduced coronary vascular reserve seen in LVH.