The beveled edge technique for harvesting of full-thickness skin grafts

BACKGROUND. Mohs surgery often uses the creation of a "beveled edge" of 45 degrees during the staged excision of skin cancers. Reconstruction of these defects frequently requires the use of full-thickness skin grafts. Because most wounds are best repaired with 90-degree edges, the beveled incision technique often used in Mohs micrographic surgery creates a wound that may need to be modified prior to reconstruction. OBJECTIVE. We present a method of harvesting the graft with a similar 45-degree angle beveled incision. METHODS. After marking, preparing, locally anesthetizing, and draping the donor site, the graft is harvested using a 45-degree angled incision. Any remaining fat is trimmed away from the base of the graft. The graft is then placed directly on the surgical defect without any "freshening" of the wound edges and is sutured into place. RESULTS. The graft takes well on the surgically created defect, leaving a cosmetically acceptable result. CONCLUSION. We have found that harvesting the graft with a beveled incision of 45 degrees, similar to taking Mohs stages, hastens the repair process. This obviates the need to remove normal tissue to create a 90-degree angle and allows for better approximation of the dermal surface area of the graft to the base of the defect.