Background
Traditionally, radial forearm free flaps are utilized for nasal lining reconstruction when local flaps cannot provide adequate coverage. However, according to our clinical observation, the skin of the forearm flap is relatively thin and prone to collapse. We presented a series of nasal reconstructions using free flaps harvested from the lower extremities to determine if the thick flap could provide more support and decrease the tendency of airway collapse.

Methods
From March 2011 to July 2021, 15 patients who underwent total or subtotal nasal reconstruction with free flap from the lower extremities (10 anterolateral thigh flap, 4 medial sural artery perforator flap and 1 profunda artery perforator flap) were identified. In addition, 15 patients who underwent free forearm flap reconstruction were also included for comparison. Nasal Obstruction Symptoms Evaluation (NOSE) score was utilized to subjectively evaluate the degree of nasal obstruction symptoms.

Results
The lower extremity group had a lower NOSE score than the forearm group. It took more time and more surgeries from the first free flap reconstruction till forehead flap reconstruction in the lower extremity group than in the forearm group.

Conclusions
Utilizing free flaps from the lower extremities in total or subtotal reconstruction of the nasal lining may decrease the tendency of flap collapse and alleviate airway obstruction symptoms, and may also reconstruct surrounding defect simultaneously compared to forearm flaps.

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