Many factors must be taken into account when deciding optimal management method for a wound including location, extent of damage, time since occurrence, concurrent injuries, presence of infectious or foreign material and blood supply. Once the decision to close a wound has been made, the type of closure to use must be chosen: primary, delayed primary, secondary or healing by second intention. For certain wounds that are extensive or in a challenging location, flaps or grafts may be a good choice for the most cosmetic and functional outcome. In this case, the patient had a wound to the scalp, for which an axial pattern graft was considered the best option. Axial pattern flaps require meticulous planning, surgery and post-operative management to maximize the chances of flap survival. Even in the best planned and executed flaps, failure is possible and may be managed in various ways. In this case,leeching and vacuum bandages were used to salvage over 90% of the flap.