Nasal floor wound coverage with an absorbable collagen matrix after revision endoscopic transsphenoidal surgery: a case report

Introduction and importance: Absorbable collagen matrices are widely used for dural repair in neurosurgery, but their application as wound dressings in the sinonasal cavity has not been reported. Donor-site morbidity after nasoseptal flap (NSF) harvest remains a clinical challenge, particularly in revision cases with limited residual mucosa. Case presentation: An 82-year-old woman with two prior transsphenoidal surgeries (15 and 11 years prior) for a clinically nonfunctioning pituitary neuroendocrine tumor presented with progressive bitemporal hemianopsia. Imaging revealed a 37-mm recurrent sellar/suprasellar mass and near-total loss of the nasal septum. Revision surgery was pursued, given her adequate general condition and progressive optic apparatus compression. Extended NSF harvest left the nasal floor bone exposed, for which autologous donor mucosa was unavailable; an absorbable collagen matrix (DuraGen) was placed as a temporary wound dressing and secured with fibrin glue. Endoscopy on postoperative day (POD) 8 showed matrix adherence with granulation tissue. At POD 28, stable crusted coverage without infection was observed. At 3 months, the nasal floor mucosa appeared regenerated on otorhinolaryngology examination. Clinical discussion: Existing donor-site coverage strategies require harvestable autologous tissue, which was unavailable in this revision setting. The collagen matrix appeared to function as a temporary scaffold during early healing, although accelerated remucosalization could not be objectively confirmed. Conclusion: Off-label collagen matrix placement over exposed nasal floor bone was technically feasible, followed by an uncomplicated course with apparent mucosal regeneration at 3 months, and should be regarded as investigational pending prospective comparative studies.