Introduction and Aims: Limb ischemia (LI) in the
newborn is a rare phenomenon defined as sudden loss of blood perfusion that can lead to necrosis if reperfusion is not performed within the first ۴-۶ hours. Its etiology can be classified into two main categories of intrauterine and postnatal causes. This condition is frequently associated with
umbilical cord torsion in uterine, affecting not only the infant's physical development but also creating notable emotional and psychological complications for families. Unfortunately, there is no specific guidelines to manage LI and its complications; on the other hand, isolated LI subsequent to
umbilical cord torsion is only reported in handful literature cases which mostly ended-up with amputation. Therefore, detailed reporting of similar cases is essential to enhance management strategies for healthcare providers. This case is reported in line with the SCARE ۲۰۲۵ criteria. Case presentation: The patient is a pre-term(۳۷weeks)
newborn male who exhibited significant left forearm and hand cyanosis with necrotic wounds (covered by wet and dry eschar, adherent slough, and blisters) and complete lack of movement in arm. Moreover, he was admitted in NICU to receive respiratory support. There were no reported prenatal complications, contributary family-history, genetic disorders or congenital anomalies besides his mother received regular prenatal care without prolonged labor. A thorough assessment reveals complete absence of sensation and radial pulse and doppler ultrasound confirmed complete absence of blood supply to the affected area. Radiological findings suggest malformed fingers and reduced bone density. These investigations led to diagnosis of a left-hand necrosis secondary to
umbilical cord torsion occurred in uterine. The management of this condition necessitated a multidisciplinary approach involving wound specialist, pediatric surgeon, orthopedic specialists, and physical therapists. In spite of considering amputation, wound specialist convinced the team to follow novel wound management process with dressing and debridement. Surprisingly, using dry dressing did not work well for healing ischemic wounds although gel-sheet form dressing through ۲۶ sessions closed the wounds with the least scar and no healing complications. Moreover, resources were provided to support the family in navigating ongoing orthopedic care. Conclusion: This case underscores the important role of wound specialists in addressing complex LI condition via choosing the best wound management plan and preventing amputation performing. Therefore, this situation highlights the need for collaborative management strategies, ultimately enhanced neonatology care practice, and continued research to develop suitable guidelines for management in similar cases.
