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  • Surgical wounds.
  • Traumatic wounds.

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Absolute

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  • Multiple comorbidities precluding safe intervention.
  • Active infection.
  • Foreign body (except surgical implants).
  • Active bleeding.

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Relative

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  • Impaired healing (corticosteroids, malnutrition, radiation, chronic disease).

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  • The wound should be fully exposed and at comfortable working distance from the surgeon.
  • A light source is often necessary in the emergency department setting.

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  • Wound edges should remain clean.
  • Sutures should be removed several days (typical in face) or weeks following repair, depending on the location of the wound and characteristics of the tissue.
  • Pain control with analgesics is appropriate.
  • Antibiotics are not necessary for most wounds but may be recommended in contaminated wounds following closure.

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  • Wound infection.
    • Infected wounds, particularly those involving deep spaces, are typically opened to prevent systemic spread.
  • Unfavorable scarring.
    • Some scarring is expected, but hypertrophic scars, keloids, or wound contraction leading to functional limitation may occur, often without a known cause.
    • Some wounds with unfavorable scarring may require scar revision.
  • Standing cutaneous deformities ("dog ears") may be a result of individual wound length differences leading to excess tissue on one side of the wound, or occur in cases in which tissue rearrangement is necessary to achieve closure.
    • These cutaneous deformities may persist and can often be addressed at primary closure.
    • To remove a standing cutaneous deformity, the tissue leading to the deformity can be lifted away from the plane of tissue and resected in an elliptical fashion.
    • If executed properly, the dimensions of the newly created ellipse will allow primary closure without a standing cutaneous deformity.

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