Surgical reconstruction of the upper extremity presents a significant challenge to both surgeon and patient. Choice of reconstructive technique requires careful consideration of a number of patient factors including age, occupation and functional status, as well as wound factors such as the size, aetiology and characteristics of the affected and adjacent tissue. The hand in particular represents a complex functional structure and successful reconstruction is essential to activities of daily living and working, whilst being a highly cosmetically sensitive area in social interactions. Necrotising soft tissue infections are limb and life-threatening conditions that require emergent and aggressive surgical debridement, antimicrobial therapy and appropriately timed, often staged, reconstruction. Following debridement, reconstruction may involve a combination of skin grafts, flaps or skin substitutes. Each option has unique advantages and disadvantages, with skin substitutes growing in popularity as newly available products become increasingly familiar to treating surgeons. We present the case of a healthy female in her 30s with necrotising fasciitis of the hand and forearm. Whilst on intensive care support and intravenous antimicrobial therapy, her wound was initially managed with serial surgical debridement and negative pressure wound therapy. Following the use of NovoSorb BTM, the area was dressed with Acticoat Flex, negative pressure wound therapy, and the limb was immobilised. The matrix integrated successfully, providing a suitable dermal layer for delayed skin grafting, to achieve a very satisfying functional and aesthetic result.