Vascular insufficiency and ischemic gangrene of the extremity is a rare, but serious complication seen in newborns. We present a newborn who developed ischemic gangrene of the left lower extremity due to prematurity, umbilical artery catheterization and septicemia, requiring a below knee amputation. Inadequate initial management, parental neglect and delayed diagnosis were other contributing factors for the undesirable outcome. Recognition of predisposing factors and identification of the high risk neonates are the major prerequisites for either appropriate measures or a successful outcome. In case of failure despite all supportive measures and proper management, amputation should be delayed until a clear demarcation has occurred. During surgery, the adjacent proximal physis should be preserved.