The Gustilo-Anderson classification is a system used to categorize open fractures based on the extent of soft tissue damage and the severity of the injury. A Gustilo-Anderson Type 3C injury specifically refers to a severe open fracture involving extensive soft tissue damage with vascular injury requiring repair. These complex injuries demand a multifaceted approach to treatment, incorporating surgical interventions and comprehensive management strategies. A 21 year old male presented to an Australian Tertiary Hospital following a motor bike accident leading to a mangled lower limb that required a multi-disciplinary approach to salvage. The injury was complicated by a delayed recognition of vascular compromise that added significant complexity to soft tissue reconstruction with respect to both adequate arterial and venous recipient selection. A multi-perforator ALT free flap was anastomosed to the descending geniculate artery with a single VC connected to the GSV proximally over the medial thigh. It was felt this late flap save was facilitated in part due to the ischaemic tolerance of fasciocutaneous free flaps. The flap was congested and successfully salvaged D5 by means of a Y-shaped vein graft. This complex flap save salvaged the option for BKA if it became necessary, but thus far has afforded complete salvage of this young patient’s leg.