The evolution of skin graft harvest knives has significantly advanced surgical techniques and improved patient outcomes in reconstructive surgery. Early procedures relied on basic knives lacking control over graft thickness, leading to inconsistent results. Blair's knife in 1930 introduced groundbreaking features like controlled depth and tension during graft removal, enhancing precision and repeatability in harvesting split thickness grafts, revolutionising graft procurement and reducing complications. Subsequent developments aimed to address limitations and enhance functionality. Finochietto's screw-adjusted knife refined graft thickness control, while Humby's instrument incorporated a roller mechanism for depth regulation offering surgeons versatility and control. Braithwaite focused on improving blade replacement mechanisms and usability driving continuous innovation. To address disadvantages like skin rolling, Watson in 1960 developed a knife with a fixed, polished stainless-steel guard and a simpler and more rigid thickness adjustment mechanism. This design allowed precise control over the depth of entry, however it introduced drag due to the guard's inability to slide affecting edge quality. Cobbett proposed a modification to reduce drag while preventing skin rolling resulting in a modified knife with improved performance. Other noteworthy knives include Goulian's adaptation of a straight razor, Snow's use of a Shick injector razor, Shoul's modification of a Gillette safety razor and Silver's disposable razor blade holder for small grafts. These innovations underscore the pivotal role of instrument development in advancing reconstructive surgery, incrementally improving surgical interventions for better patient outcomes.