In patients with large and complex wounds, the loss of normal extracellular matrix often leads to poor wound healing sequelae. Acellular dermal matrices (ADM) have been utilised since the 1990’s as an adjunct to complex wound management. They act as a dermal replacement to promote directed and structured tissue healing. In this presentation, we revisit 30 years of developments in ADM, and examine its current and emerging clinical applications. ADM were initially derived from biological tissue, including the human-derived ADM AlloDerm first clinically applied in 1994, which were depleted of cellular and immunogenic components, with the aim to reducing undesirable scarring and contracture following large area split-thickness grafting in major burns. Following excellent clinical results without host rejection, the technique has propelled far beyond the management of burns to be incorporated in the reconstruction of non-epidermal tissues, including conjunctival, gingival, tympanic membrane, and dural defects. There is ongoing interest in the adoption of ADM for abdominal hernia repairs, and significantly in breast reconstruction. Finally, more recently there has been increasing experimentation with the synthetic ADM known as Novosorb Biodegradable Temporising Matrix (BTM), which has the benefit of further evading immunogenic factors found in organic ADM. Despite its popularity within reconstructive surgery, ADM remains a relatively obscure technology within the medical community at large. The aim of this presentation is to therefore provide a basis of knowledge to guide the understanding of future applications and progress within this revolutionary field.