Background NovoSorb® Biodegradable Temporising Matrix (BTM) is a synthetic polyurethane bilayer matrix, used in trauma and burns reconstruction. However, there is little evidence of its use for paediatric limb ischaemia. We present a review of literature and three paediatric cases of sepsis-induced ischaemic limb injuries, reconstructed using BTM. Methods Data were collected on demographics, management and outcomes of three patients cared for by the senior author and plastic surgery service. The operative regimen and challenges faced are discussed. Three children, aged 1–8 years, were managed between 2022 and 2024. The first case had an immune-mediated reaction after bronchiolitis, and two cases had group A streptococcus sepsis. The first case required debridement of both lower limbs, covered with BTM, to improve scar quality and limb length. The second child had bilateral upper limb ischaemia, necessitating left below-elbow and right trans-metacarpal amputations, with BTM applied bilaterally to optimise residual limb length and stump quality. The third child underwent a right above-knee amputation and had significant soft tissue necrosis from the plantar surface of the left foot to the knee; BTM was applied to the left leg as a limb-salvage strategy. Results All cases required multiple surgical debridements, followed by early BTM application and subsequent split-thickness skin grafting. Follow-up of 1 year showed good outcomes in scar quality and preservation of limb length. Conclusion BTM has not been reported in wounds of this aetiology in the paediatric population. These cases demonstrate BTM as a valuable adjunct in reconstruction of complex wounds secondary to sepsis-induced critical limb ischaemia. Lay summary Occasionally, serious infections in children can severely reduce blood flow to parts of the arms or legs. This can cause tissue damage, often leading to amputations. Treating these injuries is difficult, especially when the aim is to save as much of the limb as possible. NovoSorb® Biodegradable Temporising Matrix (BTM) is a man-made dressing that helps the body form and organise new tissue before a skin graft is applied. It is already used for burns and other injuries, but its use in children with infection-related limb damage has been rarely reported. Question: Can BTM help rebuild and maintain residual length in children's limbs after severe infection causes loss of blood supply? Work conducted: This study reported three children, aged 1–8 years, treated between 2022 and 2024. What we did: Each child had life-threatening infections that damaged parts of their arms or legs. Surgeons removed the dead tissue in stages, utilised BTM early to protect the wounds and help new tissue organise, then later added thin skin grafts. After at least one year, all children had good scar quality and movement of the limb, and, where possible, preserved more of the affected limb. Learning points of this study: We saw promising results using BTM in these rare and complex cases. It appeared to achieve good healing and maintain residual limb length, but we do not know for sure how it compares to other treatments. Larger studies are needed to confirm these findings and guide best practice.