Background: Extremely obese pregnant women are a rapidly increasing group requiring obstetrical care. When surgical delivery is indicated they present a unique challenge. Case: We submit the case of a pregnant woman with a body mass index (BMI) of 63Kg/m² (385 pounds) with a reduced pelvic outlet who selected to deliver by primary cesarean. A sub umbilical Joel Cohen incision was selected. The surgical procedure and delivery were uneventful. Twelve hours post-surgery a circumferential area of skin redness was present in the area where the wound protector-retractor was placed. We believe this represented an area of relative ischemia created by the pressure between the two plastic rings of the device. There was no pain or inflammation, the area returned to normal within 48 hours. Conclusion: We are not aware of a similar case reported with the use of this device. Practitioners are alerted to this event and reminded that the deployment of the device must be carefully performed to avoid this possible deleterious effect.