Preoperative Methylene Blue Mapping During Medial Thighplasty: A Technical Note with Preliminary Clinical Experience in 10 Patients

Background/Objectives: Medial thighplasty after massive weight loss is associated with wound dehiscence, seroma, prolonged edema, and potential alterations in lower-limb lymphatic drainage. Conventional refinements rely largely on the surgeon’s understanding of distorted lymphatic anatomy. We describe a simple adjunct using preoperative intradermal methylene blue injection to visualize linear structures morphologically consistent with superficial lymphatic pathways during medial thigh lift. Methods: After standard preoperative markings, dilute methylene blue was injected intradermally along the planned medial thigh resection pattern after induction of anesthesia and before skin preparation. During flap elevation, discrete blue linear channels were identified within the superficial adipose layer. Resection was performed down to, but not through, the plane of these channels, which were preserved on the residual bed and avoided during suspension suturing and liposuction. Between December 2021 and December 2022, the technique was applied in 10 non-consecutive female patients after massive weight loss. Results: Blue-stained linear channels were identified in all 10 selected cases. No patient required reoperation or readmission. Minor wound-healing complications occurred in 5 of 10 patients and were managed on an outpatient basis. Conclusions: Intradermal methylene blue injection permits intraoperative identification of stained linear channels during medial thighplasty and can be incorporated without specialized equipment. Their lymphatic identity and postoperative patency were not confirmed by histology or functional imaging. In the absence of a control group and inferential analysis, any lymphatic-sparing effect remains unproven and requires prospective controlled evaluation with objective lymphatic outcomes.