In an industrial washroom, photographer Adam Faulkner (Leigh Whannell) and Dr. Lawrence Gordon (Cary Elwes) are chained by their ankles to pipes at opposite corners. Between them is a corpse (Tobin Bell) holding a revolver and a microcassette recorder. Lawrence and Adam discover tapes in turn saying "Play Me." From the tape, Adam is told that he must escape the bathroom, while Lawrence is told that he must kill Adam before six o'clock, or else his wife and daughter will be killed and he will be left to die where he sits. Hacksaws are soon discovered; neither is sufficiently sharp to cut through their chains, and Adam throws his away in agitated frustration. Lawrence realizes that the saws are not meant for the chains, instead for their feet.
The film opens with Michael, a police informant, finding himself ensnared in a deadly trap created by the Jigsaw Killer. A videotaped message informs him that a Venus flytrap-like helmet full of spikes has been locked around his neck and will close on his head unless he finds the key in time. Michael realizes, through hints left by Jigsaw, that the key has been implanted behind his right eye. He finds a scalpel nearby, but cannot bring himself to cut out his own eye; when the timer runs out, the device slams shut, killing him instantly
This film begins immediately after the end of Saw II, with Detective Eric Matthews (Donnie Wahlberg) escaping the bathroom he was left in by breaking his foot to slip out of his ankle chain(although his first thought was to cut his own foot off after seeing the severed foot of Dr. Lawrence Gordon). Later flashbacks depict his vicious fight with Amanda Young (Shawnee Smith), who eventually overcomes him and leaves him for dead. Before she leaves, Matthews shouts several angry parting comments, calling Amanda a "junkie bitch" and telling her she is nothing compared to Jigsaw, causing her evident distress. What she does next is not revealed at this time. Other flashbacks show that Amanda had been working with John Kramer, the Jigsaw Killer (Tobin Bell), prior to the events of the first film, and had been the one who actually instigated the abduction of Adam under Jigsaw's orders. After the events of the first film, it is revealed, she had suffocated Adam in a mercy killing.
At the autopsy of the Jigsaw Killer a wax-coated microcassette is found in his stomach, which, when played for Detective Hoffman, promises that "the games have just begun" and that he "hopes that he will succeed where others have failed" in his test as he is "the last man standing."
In a mausoleum, where Trevor and Art are chained to a large device. Trevor's eyelids have been sewn together, and Art's mouth has been sewn shut, making communication between them impossible. When the device begins pulling them together, they panic, and Art murders Trevor to retrieve a key from his collar.
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