Harvesting a split skin graft

This acrylic on canvas image painted by Brian Morgan is an intraoperative view depicting the harvest of a split skin graft.

This is an oft repeated scene in a plastic surgical theatre. It is one of the first procedures, and skills, that aspiring plastic surgeons learn to master. 

The donor site for this graft is the skin of the thigh. The Braithwaite or Humby type skin graft knife has a disposable blade and is set to take a thin sheet of epidermis and a variable, but predictable thickness of underlying dermis. The knife blade will have been set to the desired thickness using the locking wheels at either end of the leading edge blade guard. 

Note that the assistant is pressing down, and retracting the thigh skin to render it flat and taught. Once lubrication is applied, the knife is pressed down at a very slightly inclined angle to the skin, being then moved reciprocally back and forth, whilst advancing down the thigh. The thin sheet of skin being harvested is seen gathering above the blade. The raw, exposed and pale remaining dermis is seen behind the advancing knife. It is from sweat glands and hair follicles remaining in this dermis that the skin will resurface itself over approximately two weeks once dressed.