Varicose ulcer, a severe symptom of chronic venous insufficiency, may be refractory to treatment when accompanied by bone exposure. The lack of a blood supply and fresh granulation tissue on the exposed bone can result in a protracted healing time. A 59-year-old man suffered from varicose veins for 10 years, a varicose ulcer for 1 year, and an exposed right tibia for 40 days after using traditional Chinese medicinal plasters. The patient was treated with conventional high ligation and stripping of the great saphenous vein, segmental endovenous laser ablation, bone drilling, and a free skin graft. Patient outcome is satisfactory 2 years after discharge. We present a rare case of varicose ulcer in association with bone exposure. Tibia drilling with Kirschner wire was used to allow blood flow and provide nutrients for the formation of granulation tissue over the exposed bone and wound healing. Subsequently, free skin grafting was used during reconstructive surgery to replace skin loss on the right calf. Physicians encountering this rare condition in clinical practice should consider our treatment approach as a successful limb-preserving option for these patients.