Specific wound closure techniques should take into account the potential for scar formation to occur in an undesirable location. This can happen when a wound must be elongated to create parallel lines and to decrease the tension on the wound edges. Elongation of a wound may bring it into proximity of other anatomic positions or landmarks, thus further complicating the healing process. If not planned well, excessively large defects may result, making it more likely that the scar will require later revision. More obvious conditions may exist that compromise complex wound closures. Particular attention must be given to crush injuries with devitalized or contaminated tissues. Severely contaminated wounds, including those with prolonged exposure, generally are at greater risk of infection with multilayer closures. Do not perform these techniques if the patient is at risk for poor wound healing (i.e., diabetes, poor vascular supply to the area, or prior radiation therapy to the area), keloid formation, or coagulopathic. Careful wound assessment may result in a decision to use simple approximation of the wound edges with close follow-up for ongoing wound care. Contraindications to complex wound closures will at times be reliant on temporal factors, such as the need to close a wound prior to the patient receiving surgical intervention for more life-threatening injuries. There must be a commonsense approach in deciding how to close more challenging wounds in the Emergency Department.