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Updated: Feb 3, 2026

Toluidine Blue Staining of Resin-Embedded Sections for Evaluation of Peripheral Nerve Morphology
Published on: July 3, 2018
Acute edema induced by toluidine blue extravasation-first report
Uwe Wollina1, André Koch2, Birgit Heinig3
1Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Friedrichstraße 41, 01367, Dresden, Germany. Uwe.Wollina@klinikum-dresden.de.
Abstract:
Methemoglobinemia is characterized by an increased level of methemoglobin (MetHb) in the peripheral blood. MetHb levels increase after tumescent anesthesia and need to be monitored. If a patient becomes symptomatic and/or the MetHb levels increase >10%, intravenous injection of an antidote is recommended. Toluidine blue is twice as effective as methylene blue in this respect.A 27-year-old woman with advanced lipedema underwent her third liposuction under tumescent anesthesia. After surgery, her MetHb levels increased and needed injection of toluidine blue. She developed an acute and painful edema after extravasation of some toluidine blue due to a bursting vein. This is the first report in the recent medical literature. Clinical presentation, course, and treatment are described.
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