Transpositional adipofascial flap and full thickness skin graft were used successfully on a 27-year-old woman who sustained a large soft tissue defect on the ulnar side of the right index finger due to machine mangling injury. Using transpositional adipofacial flap one-stage procedure, excellent coverage for the exposed tendons, bones and joints was achieved. This procedure facilitates early wound recovery, early range of motion for the finger joints, reduction of wound pain and minimal scar formation. It also provides excellent esthetic and functional results.