Integra® Bilayer Wound Matrix is composed of cross-linked bovine tendon collagen and glycosaminoglycan with a semi-permeable polysiloxane membrane. This bioengineered tissue provides a matrix for organized cellular migration and proliferation needed to facilitate wound healing while minimizing an inflammatory response. The scaffold provided by Integra® Bilayer Wound Matrix is particularly helpful for building a durable base for coverage of deep soft tissue defects in wounds of all types. We consider the current literature on Integra® Bilayer Wound Matrix and discuss the peri-application management, as well as introduce our treatment algorithms for its use in complex soft tissue reconstruction in the lower extremity.