Finding a good and durable substitute to trachea and proximal airways has remained the holy grail for thoracic surgeons for many decades. Autologous tracheal reconstruction using armed forearm free flap with rib cartilage achieved satisfactory results in managing extended tracheal lesions without the need for synthetic materials or immunosuppression. This well-vascularized and rigid neo trachea limits postoperative airway collapse, mediastinal infection, and ischemic airway issues, and achieves long-term functional benefit and prolonged survival. Further improvement is needed to deal with the lack of mucociliary clearance for longer airway replacement involving trachea and bronchial bifurcation.