Step 1

For the Sausage Mix: In a medium bowl, combine pork, garlic, salt, pepper, and nutmeg and stir with a wooden spoon to evenly distribute seasoning. Add 2 tablespoons (30ml) chilled wine and stir vigorously with wooden spoon, working meat mixture against bottom and sides of bowl, until wine is incorporated and mixture becomes tacky and sticky, 1 to 2 minutes. Cover and refrigerate for at least 1 hour and up to 2 days.Alternatively, combine pork, garlic, salt, pepper, and nutmeg in bowl of a stand mixer fitted with the paddle attachment. Mix on low speed until seasonings are evenly incorporated, about 1 minute. Add wine, increase speed to medium, and mix until wine is incorporated and mixture becomes tacky and sticky, 1 to 2 minutes. Cover and refrigerate for at least 1 hour and up to 2 days.

Step 2

For the Pasta: When ready to cook, remove sausage mixture from refrigerator and, using clean hands, form into four 1/2-inch-thick patties (don't worry about making them perfectly round as they will get broken up into smaller pieces; if using store-bought sausage, form uncased sausages into 1/2-inch-thick patties). In a large skillet or straight-sided sauté pan, heat oil over medium-high heat until shimmering. Add sausage patties and cook until bottom side is light golden brown, 3 to 5 minutes. Using a thin metal spatula, turn sausage patties onto uncooked side, leaving an open area in the center of the skillet. Add onion, lower heat to medium, and cook, using a wooden spoon to break up sausage into 1/2- to 1-inch pieces, until sausage is just cooked through and onion is softened, about 2 minutes; lower heat at any point if sausage or onion threaten to scorch.

Step 3

Increase heat to medium-high and add wine. Bring to a simmer and cook, swirling pan and scraping up any stuck-on bits with a wooden spoon, until wine is reduced by roughly half, about 30 seconds.

Step 4

Add cream, bring to a simmer, and cook, stirring frequently to keep cream from scorching on sides of the pan, until sauce is slightly thickened, 3 to 5 minutes. Season with salt and pepper to taste and reduce heat to lowest possible setting to keep sauce warm and prevent it from over-reducing.

Step 5

Meanwhile, in a pot of salted water, cook pasta until just shy of al dente (about 2 minutes less than the package directs). Using a spider skimmer, transfer pasta to sauce, along with 1/2 cup (120ml) pasta cooking water. Alternatively, drain pasta using a colander or fine-mesh strainer, making sure to reserve at least 1 cup (240ml) pasta cooking water.

Step 6

Increase heat to high and cook, stirring and tossing rapidly, until pasta is al dente and sauce is thickened and coats noodles and pools around edges of the pan, about 2 minutes; add more pasta cooking water in 1/4-cup (60ml) increments as needed to achieve desired consistency.

Step 7

Remove from heat, add Pecorino Romano, and stir rapidly to incorporate. Divide between warmed serving bowls, top each portion with a grinding of black pepper, grated nutmeg, cheese, and truffle (if using). Serve immediately.