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Adequate local anesthetic, in harvesting a split-thickness skin graft (SSG), traditionally involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetize an SSG donor site with one injection, in one pass, of one needle. 1. Preop application of EMLA cream/AMITOP to the donor site 2. Mix 10 mL 1% lidocaine solution with Adrenaline 1:200,000 with 1 vial of Hyaluronidase 1500 units. The mixture is buffered with 1 mL 8.4% sodium bicarbonate to neutralize acidity and minimize pain. 3. Mark out the SSG donor site 4. Using a 27-G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anesthetic subdermally, creating a mound. 5. Change the angle of the needle to 180° and continue to inject the remaining anesthetic along one half of the width of the donor site. 6. Using a rolled 4 × 4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site. 7. As the mound advances, the hyluronidase/anesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution. The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distributing the anesthetic uniformly across the donor site, and facilitating the acquisition of an SSG of uniform thickness

For biopsy proven skin cancers that are deemed to be high risk, a wide local excision (WLE) is recommended to reduce the risk of local recurrence. For this reason, it is pragmatic to account for the likelihood of a WLE at the time of the initial biopsy. We illustrate a staged approach to excision of lesions to facilitate this, bearing in mind the optimal reconstruction is primary closure. In our experience as plastic surgeons, having to perform a locoregional flap or skin graft prevents the opportunity to perform a local anesthetic procedure. This increases the risk of postoperative complications, especially if adjuvant radiotherapy further exposes reconstructed tissues to radiation toxicity. Collectively, this often results in an inferior aesthetic outcome. We value the referrals from allied colleagues and want to share the principles we adhere to when planning an excision biopsy, which aid in the delivery of the optimal reconstruction.