Autologous skin grafting as a reconstructive technique is a mainstay in the toolkit of a plastic and reconstructive surgeon. Interestingly, the history of skin grafting as a procedure is both violent and opportunistic. Earliest known depictions of skin grafting date back to Ancient India where facial mutilation, especially of the nose, was widely practised as a form of punishment. Techniques developed in this period by the renowned Indian surgeon Sushruta and members of the tilemaker caste of potters included pedicled forehead flaps for nasal reconstruction and free skin grafts harvested from gluteal skin after being traumatised into oedema. It was not until the late 19th century that modern skin grafting techniques began to enter the mainstream scientific discourse. Key technical refinements by Jacques-Louis Reverdin in 1869, LXEL Ollier in 1872 and Carl Thiersch in 1886 led to recognition of the importance of the depth of graft harvest in healing both the graft and donor site. This, in turn, has shaped the development of instruments that improve control over the depth of graft harvested. Early split thickness grafts were harvested with long thin blades without adjustable mechanisms, such as in the Catlin Knife. Throughout the 20th century, graft knives were refined to improve their depth selection, skin tension and usability. In 1939, the first calibrated dermatome was introduced by Earl Padgett, before the electric dermatome developed by Harry Brown in 1948 formed the basis of the dermatome still used today. This presentation will summarise key contributions and developments in the history surgical instruments used in skin grafting.