Physical restoration of damaged tissue when the wound requires more than layered closure as with scar revision, débridement (e.g., traumatic lacerations or avulsions), extensive undermining, stents, or retention sutures. Necessary preparation includes creation of a defect for repairs (e.g., excision of a scar requiring a complex repair) or the débridement of complicated lacerations or avulsions. Other examples are reconstructive surgery; complicated wound closure; skin grafting; intricate, unusual, and time-consuming methods to get maximum function and cosmetic results; and creation of a defect by extending excisions.