Nasal Reconstruction Using a Synthetic Dermal Substitute: An Updated Algorithm and Clinical Outcomes

Nasal reconstruction is uniquely challenging due to complex contour, variable skin thickness, and the need to preserve both function and aesthetics. While the paramedian forehead flap and local flaps remain standards for complex defects, synthetic dermal substitutes such as NovoSorb Biodegradable Temporizing Matrix (BTM) have emerged as useful adjuncts. However, published experience with BTM in nasal reconstruction remains limited to small case series with narrow indications. This study evaluates clinical outcomes following nasal reconstruction with BTM across all nasal subunits and proposes an updated reconstructive algorithm incorporating its use. A retrospective review was performed of all patients who underwent nasal reconstruction using BTM between January 2023 and October 2025 by a single surgeon at a tertiary academic center. Patient demographics, defect characteristics, operative details, complications, healing time, and secondary procedures were recorded. Outcomes were analyzed descriptively. Sixty-seven patients were included, with a mean age of 70.4 years and an average follow-up of 3.2 months. The mean defect size was 4.68 cm2, and 17.9% involved nasal lining defects. The overall complication rate was 7.46%, including 1 infection and 4 cases of delayed healing. Twelve patients (17.9%) underwent secondary surgical procedures, most commonly planned paramedian forehead flaps. Nineteen percent underwent in-office aesthetic refinement. BTM functioned as definitive reconstruction, a temporizing measure, or a preparatory step for staged reconstruction. BTM is a safe and versatile adjunct for nasal reconstruction across all nasal subunits, offering low complication rates, favorable contour preservation, and reliable healing. These findings support an updated nasal reconstruction algorithm integrating BTM as a definitive, temporizing, and adjunctive reconstructive option.