Pixel array medical devices, systems and methods are described for skin grafting and skin resection procedures. The procedures involve applying a scalpet array to a target skin site. The scalpet array comprises scalpets positioned on an investing plate. Skin pixels are circumferentially incised at a target skin site by applying a load via the scalpet array onto subjacent skin surface that includes the target skin site. Incised skin pixels are captured on an adherent substrate, where the incised skin pixels are extruded through the scalpet array. Bases of incised skin pixels extruded through the scalpet array are then transected.