Purpose: Large keloid scars are a common presentation to the Plastic and Reconstructive Surgery clinic in at Royal Darwin Hospital in Northern Territory, Australia. Large keloid scars are often painful, itchy and unsightly. Surgical excision is a management option for those keloids that have failed non-operative management, however this is associated with a very high risk of recurrence (>70%) and often the remaining defect is too large to be closed primarily without undue tension, requiring the use of reconstructive techniques such as local flaps or skin grafting. Method: A retrospective review was undertaken of patients who underwent excision of a large keloid scar and reconstruction using BTM, followed by split-thickness skin grafting at the Royal Darwin Hospital. Results: Following keloid excision, BTM rapidly integrated into the wound bed, with skin grafting undertaken between 2 and 4-weeks following its application. There were no instances of infection or graft loss recorded. In short-term follow up there have been no significant instances of keloid recurrence. Conclusion: BTM is a valid reconstructive option for defects following excision of large keloid scars. Larger prospective studies with long-term follow-up are required to assess the long-term outcomes of BTM in this clinical scenario, scar quality and the rates of keloid recurrence especially beyond one year.