Abstract: LU Xin-feng*, GU Yong-gui, ZHAO Liang, LIU Yi-qiu, CHEN Jing, ZHANG Qian, WU Jian. *Jingjiang People's Hospital, Jingjiang 214500, Jiangsu, China Corresponding authors: ZHAO Liang, Email: pfwkchina@aliyun.com; WU Jian, Email: WU6969@sina.com 【Abstract】 Objective To develop a new strategy for preparing large-area full-thickness skin grafts with donor incisions small enough to allow direct suture under low pressure. Methods A geometrical analysis was carried out to design the best strategy to obtain skin grafts with minimal donor defect. In this strategy, two semicircular donor skin grafts are subjected to a malpositioned joining to form a circle which is equal in size to the large-area skin defect. Seven patients with cutaneous malignancy were managed by this operation regimen, including three cases of basal cell carcinoma, three cases of squamous cell carcinoma, and one case of malignant melanoma. Tumors were located in the face or head in five patients, and in feet in two patients. Results The width of donor incisions was significantly reduced by this strategy, and donor defects were sutured directly with the minimal loss of donor graft. Of the five patients with malignancies of the head or face, three achieved complete survival of skin grafts, two experienced mild erosion at the margin of skin grafts. A 10%－20% necrosis of skin graft was observed in the sole of feet in 2 patients, which healed 1－2 months after dressing changes. Conclusion Joined grafts of equal size may be an effective approach to the repair of large skin defect.