The consequences of deep burns to the hands and face are the most challenging we encounter in modern reconstructive surgery. In many cases, the simple autotransplantation of full-thickness defects with split-thickness skin grafts is now considered inadequate or outdated. For this and many other reasons, the use of dermal substitution is on the rise as it provides improved cosmetic effects and skin compliance, reduces contractility and greatly approximates the histological image to normal, healthy skin. For the purpose of this article, we present a dermal substitution, Matriderm (R), in the case of extensive thermal trauma in a 6-year-old boy.