Indications Deep wounds, when closing just the epidermal layer might leave significant pockets of dead space Wounds under increased tension, which require strong dermal closure to heal optimally Wounds prone to keloid formation, to minimize wound skin tension Lacerations that require extended healing, in which a nonabsorbable dermal suture is left in place for a longer period than recommended with a surface suture Contraindications Absolute contraindications None Relative contraindications Inadequate or thin dermal layer Wound that cannot be adequately cleaned (however, there is no increased risk of infection using dermal sutures in clean wounds) Sutures of any type may be contraindicated for wounds that are contaminated, relatively old, or that would be at higher risk of infection if closed by sutures, such as small bites to hands or feet, puncture wounds, or high-velocity missile wounds.