Management of tibial vascular injuries in conjunction with severe soft tissue and skeletal injury is very challenging. Mangled Extremity Severity Score (MESS) is well-known grading system for such limbs. MESS >7 warrants primary amputation. We describe a case of successful limb reconstruction for a mangled limb on a 28-year-old male. Considering his age, hemodynamic stability and muscle viability, he underwent posterior tibial artery reversed saphenous vein graft repair. A month after the reconstruction, he had cosmetically sound non-infected leg. This case suggests even when the injury-related scores are high, in a young patient with viable muscles, reconstruction should be considered.