Lymphatic-Sparing Medial Thighplasty Using Preoperative Methylene Blue Mapping

Medial thighplasty after massive weight loss carries high rates of wound dehiscence, seroma and prolonged edema, and there is evidence that thigh lift can alter lower limb lymphatic drainage. Conventional refinements such as liposuction assistance, limited undermining and fascial anchoring still rely on the surgeon’s implicit understanding of distorted lymphatic anatomy in post bariatric tissues. Direct intraoperative visualization of lymphatic pathways is not part of routine practice. We describe a simple adjunct based on preoperative intradermal methylene blue injection to map superficial lymphatic collectors before medial thigh lift. After standard markings in the standing position, a dilute methylene blue solution is injected intradermally along the planned medial thigh resection pattern once anesthesia is induced and before skin preparation. At flap elevation, lymphatic collectors appear as fine blue channels within the dermis and immediate subdermis, running parallel to the great saphenous axis and defining a practical limit for safe depth of dissection. The surgeon maintains dissection superficial to the stained collectors and avoids transfixing them with suspension sutures or deep liposuction passes. The technique is particularly useful in massive weight loss patients with thin, inelastic skin and deep folds in whom depth perception is unreliable, and for less experienced surgeons who are still developing three dimensional familiarity with the medial thigh. Methylene blue is inexpensive and easily integrated into the operative workflow without specialized equipment or relevant time cost. This lymphatic sparing mapping strategy merits prospective evaluation regarding its effect on seroma, lymphocele and postoperative edema after medial thighplasty.