Purpose The rate of non-melanoma skin cancers in Aotearoa is the highest in the world and reconstruction after surgical excision, particularly in the elderly and comorbid populations, remains a challenge. The recent introduction of synthetic skin substitutes such as Biodegradable Temporizing Matrix (BTM) offers an alternative to traditional methods of reconstruction. This retrospective audit aimed to assess the outcomes of reconstruction with BTM without secondary skin grafting. Methodology This retrospective case series identified 58 patients who had the excision of a head or neck non-melanoma skin cancer under local anaesthetic in the ORL Department of Whangarei Hospital. Patient demographics, skin cancer type, surgical details, complications and patient satisfaction were recorded along with pre- and post-operative clinical photographs. Results Of the 58 patients, none required secondary grafting over the BTM with satisfactory healing occurring via secondary intention in all cases. Three (5.2%) patients experienced a post-operative infection, one of which required removal of BTM. One (1.7%) patient required re-excision due a positive margin. Self-reported patient satisfaction with the surgical outcome was high. Conclusions When planning reconstruction after excision of a head or neck malignancy the surgeon must consider the oncological margins, the patient’s functional status and comorbidities and the resources required both intraoperatively and for post-operative care. This retrospective audit suggests that the use of BTM without secondary skin grafting is a low risk, well-tolerated approach to reconstruction that produces aesthetically acceptable outcomes. This method may be particularly useful in elderly and comorbid populations as it avoids donor site morbidity and the need for second stage procedures.