Dermal regeneration template as a scaffold for mucosalization of the internal lining of the forehead flap in complex nasal reconstruction: A novel strategy

Background: Reconstruction of the nasal lining is one of the most technically demanding aspects of total nasal reconstruction. Traditional techniques such as folded flaps, mucosal grafts, and skin substitutes have limitations in terms of volume, donor site morbidity, and long-term functional outcomes. Dermal regeneration templates (DRTs) have recently gained attention for their regenerative potential in complex wounds, but their application in intranasal mucosal regeneration remains underreported. Methods: We present the case of a 77-year-old man with a third recurrence of basal cell carcinoma involving the nasal pyramid. Following radical resection of the nasal skeleton and anterior septum, total nasal reconstruction was performed using a contralateral forehead flap. The internal surface of the flap was lined with a single-layer dermal regeneration template. The nasal framework was rebuilt with autologous costal cartilage. Additional mucosal advancement flaps were used to cover the new septum. Results: Histological analysis performed two weeks after flap inset revealed early neomucosa formation adjacent to the dermal template. A second biopsy performed at one-year follow-up confirmed complete mucosalization of the inner lining, with mature glandular structures integrated within the tissue. No postoperative complications were observed, and the patient reported satisfactory functional and aesthetic outcomes. Conclusions: This case represents the first documented instance of spontaneous mucosalization of a dermal regeneration template used as inner lining in total nasal reconstruction. The findings suggest that DRTs may serve not only as passive scaffolds, but also as active promoters of mucosal regeneration when placed in a suitable environment. This approach may offer a valuable alternative in cases where conventional lining options are limited or contraindicated.