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Photographer Adam Stanheight awakens in a dilapidated bathtub, with his ankle chained to a pipe. Across the room is oncologist Dr. Lawrence Gordon, also chained, and between them is the corpse of an apparent suicide victim holding a revolver and a microcassette recorder. Both men find a tape in their pockets, and Adam retrieves the recorder. Adam's tape urges him to survive, while Gordon's tells him to kill Adam by six o'clock or his wife Alison and daughter Diana will be killed. Adam finds a bag containing two hacksaws inside the toilet which they try to use to cut through their chains, but Adam's saw breaks. Gordon realizes that the saws are intended for their feet, and identifies their captor as the Jigsaw Killer, a serial killer testing his victims' will to survive through lethal traps referred to as "games", whom Gordon knows of because he was once a suspect.

Five months prior, Gordon, while discussing the terminal brain cancer of patient John Kramer, was interrogated by Detectives David Tapp and Steven Sing, who found his penlight at the scene of one of Jigsaw's games. Gordon's alibi cleared him, but he agreed to view the testimony of heroin addict Amanda Young, the only known survivor of one of Jigsaw's traps, who had been forced to kill and disembowel a man to obtain a key to free herself. After Gordon's release, Tapp and Sing find Jigsaw's warehouse using the videotape from Amanda's game. There, they apprehend Jigsaw and save a man from a trap, but Jigsaw injures Tapp and escapes. Sing pursues Jigsaw down a hallway where he accidentally triggers a shotgun trap and is killed.