Background
We present a SCARE (Surgical Case Report) guidelines compliant case describing the staged reconstruction of a complex traumatic axillary defect in a 19 year old man following a high energy road traffic injury.

Case Presentation
The patient sustained a deep degloving wound of the axilla with exposure of the humeral head and open shoulder joint, partial loss of the latissimus dorsi and biceps muscles, and an associated lower limb degloving injury. After initial resuscitation, serial debridement, and infection control, definitive reconstruction was performed one month later using a free anterolateral thigh (ALT) flap with split thickness skin grafting.

Surgical Technique
Because the usual thoracodorsal recipient vessels were affected by the injury, the flap was anastomosed to the pectoral branch of the thoracoacromial artery and vein, with additional venous drainage through the cephalic vein.

Outcomes
The flap survived, graft take was largely successful. Physiotherapy was initiated at 2 weeks postoperatively and sustained upon discharge. At 6 months the patient had preserved shoulder range of motion, though with some difficulty initiating abduction, likely related to associated rotator cuff injury.

Discussion
The case highlights important considerations when reconstructing axillary defects with emphasis not only on defect closure, but also functional preservation and/or restoration.