Between the events of 'Saw' and 'Saw II', a sick and desperate John Kramer travels to Mexico for a risky and experimental medical procedure in hopes of a miracle cure for his cancer, only to discover the entire operation is a scam to defraud the most vulnerable. Armed with a newfound purpose, the infamous serial killer returns to his work, turning the tables on the con artists in his signature visceral way through devious, deranged, and ingenious traps.

When clues to his brother's murder lead Poncho to a fire brigade, he joins it to investigate further and finds romance, family... and a serial killer.