Background In full-thickness nasal defects, the intal lining is perhaps the most challenging aspect of the three layers to rebuild. Nasal damage is usually more concentrated on the tip, soft triangles, alar wings, and columella, but the lateral nasal arteries are often left intact and the damage to the dorsal sidewalls are normally superifcial. Methods Twelve patients who required total nasal reconstruction received a forehead flap placement as extal coverage and autologous rib cartilage as structural support. Residual normal/superifcial scar tissue lfaps on the dorsal sidewalls with lateral nasal artery pedicles were mobilized and designed for intal lining repair without creating secondary donor site damage. The lfaps were then ted 180° downward and placed between the alar medial angles and the fix.Results No total lining lfap necrosis occurred in all the patients. Partial necrosis occurred on the distal edge owing to overpressure of the nostril splint to the flaps; however, the wounds eventually healed, and the nasal structural integrity was preserved. The patients were satisifed with the aesthetic results and had no complaints of airway stenosis. Conclusions Lateral nasal artery pedicle dorsal sidewall skin flaps are appropriately thick, providing enough nostril circumferential support to improve airway stenosis. It allows sufifcient blood supply and creates no extra donor site damage. Blood vessels and skin flaps are often undamaged, thereby allowing maximum application in total nasal reconstruction.