1)Under aseptic /sterile operating conditions the blade is inserted into the knife being careful not to damage the cutting edge of the blade by striking it to metal. Also be careful not to injure yourself as the blade is very sharp.

2)The blade retaining plate is then fitted. Note that it is asymmetrical, the shorter section is applied over the free blade edge. Incorrect fitting of the blade retaining plate so that the retaining plate overlies the free edge of the blade means it can strike the handle body near the lateral free edges of the blade.

3)Insert and tighten the fixing nut to firmly hold the blade in the knife. 
4)The thickness of the graft to be harvested is determined by adjusting the two thumb screws on each upper side of the knife. The thumb screws move the harvesting guide either closer to, or further from the blade and change the thickness of the harvested graft accordingly. Turn thumb screws equally to maintain the blade parallel to the harvesting guide.

5)Split thickness grafts vary in thickness from thin (0.008 of an inch) to medium (0.010 of an inch) to thick (0.012 of an inch).

6)A Swann-Morton No.15 scalpel blade can be passed between the blade and guard to check selected thickness prior to harvesting a graft. The thickness of the disposable 15 blade is 0.394mm or 0.0155 inch. If the number 15 blade passes freely between the skin graft disposable blade and the harvesting guide this will provide a thick split thickness skin graft. This is useful if harvesting from the anterior or lateral upper thigh.

7) If the forearm or arm is chosen select a thin to medium thickness split thickness skin graft. The number 15 disposable blade will only pass part way to the bevel. The recipient site will determine how thick a graft you wish to harvest.
8)After appropriate anaesthesia and application of lubrication such as liquid paraffin to the donor site and skin graft knife, the graft is harvested by steadily moving the blade back and forth at the same time stretching the skin to hold it firm.