We present the case of a 4-year-old male patient, who presented a fat pad injury due to severe degloving associated with an exposed Gustilo Anderson III-B calcaneal fracture plus section of the Achilles tendon, initially managed in another institution with multiple surgical washings plus debridements and skin graft in the heel; however, he presented wound dehiscence, ulceration in the graft area and Cierny Mader III-A chronic osteomyelitis. Given the complexity of the picture, he was referred to our institution for comprehensive resolution of the injury with ostoplastic approach: correction of equinus deformity with Ilizarov type external fixator, reverse flow sural flap, calcaneal bone curettage and lengthening of the Achilles tendon with satisfactory resolution of the case.