Purpose: Mycobacterium ulcerans infection (Buruli ulcer) is an environmentally acquired necrotising soft tissue infection endemic to parts of Australia. Presentation outside endemic areas may delay diagnosis and increase morbidity. This case highlights key learning points for clinicians in non-endemic settings. Methodology: A 70-year-old right-hand dominant cattle farmer with type 1 diabetes from rural South Australia presented with progressive dorsal hand cellulitis unresponsive to oral and prolonged intravenous empirical antibiotics. With progression to necrotic ulceration, he was transferred to a tertiary Plastic and Reconstructive Surgery service. Results: Despite more than two weeks of broad-spectrum IV antibiotics, infection progressed, requiring multiple surgical debridements prior to diagnosis. Ziehl–Neelsen staining demonstrated acid-fast bacilli, and mycobacterium ulcerans was confirmed by PCR following recognition of recent travel to an endemic region. Definitive reconstruction was achieved using a pedicled reverse radial forearm flap. The patient completed a 12-week course of rifampicin and clarithromycin, resulting in resolution of infection. Intensive hand therapy was required during the tertiary admission and following discharge. Approximately one year later, revision surgery was undertaken, including little and ring finger extensor tenolysis, fourth web space contracture release, and flap thinning, followed by further hand therapy to optimise function. Conclusion: Early recognition and prompt targeted antimycobacterial therapy for Buruli Ulcer may prevent significant tissue loss, reducing the need for complex reconstruction and associated prolonged rehabilitation. Downstream benefits include reduced morbidity, length of stay, loss of productivity and healthcare costs. Improved clinician awareness in non-endemic areas is essential to optimise outcomes and reduce healthcare burden.