Necrotic injury of an extremity in a donor twin is a rare complication of twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation. We present the case of a 20-year-old gravida 2, para 1 with a twin gestation with severe twin-twin transfusion syndrome (Quintero Stage 3B) who had treatment with selective fetoscopic laser photocoagulation. Selective fetoscopic laser photocoagulation may be associated with extremity necrosis in a donor twin.