Morphometric Analysis of Thigh Perforator Arteries Using CT Angiography: A Bilateral Comparative Study

Background/Objectives: The thigh provides several perforator-based donor sites, but comparative computed tomography angiographic data describing anterolateral thigh (ALT), anteromedial thigh (AMT), and posteromedial thigh (PMT) perforators bilaterally remain limited. This study aimed to characterize CTA measurability, caliber, and side-to-side variability across these three territories. Methods: A total of 176 archived CTA records were screened. After predefined clinical/imaging exclusions and reconciliation of duplicated protocols, 49 unique patients with bilateral thigh imaging (98 lower limbs) were included. Patient-level measurable-perforator rates with 95% Wilson confidence intervals (CIs) were calculated. Side-to-side measurability was assessed with exact McNemar tests, territory differences with Cochran's Q tests, and paired diameters with Wilcoxon signed-rank tests; Holm correction was applied within families of multiple comparisons. Results: PMT perforators were measurable in 75.5% of patients on each side (95% CI 61.9-85.4%), ALT in 51.0% on the left (37.5-64.4%) and 61.2% on the right (47.2-73.6%), and AMT in 24.5% on the left (14.6-38.1%) and 42.9% on the right (30.0-56.7%). Side-to-side measurability differed for AMT (exact McNemar p = 0.0117) but not ALT (p = 0.180) or PMT (p = 1.000). Paired ALT maximum diameter was 1.86 ± 0.27 mm on the left and 1.59 ± 0.42 mm on the right, but the bilateral difference was not statistically significant after Holm correction (adjusted p = 0.0588). No territory showed a statistically significant bilateral diameter difference after multiplicity correction, and overall maximum diameter did not differ among territories (p = 0.408). Among 17 patients with no measurable ALT perforator on either side, 15 (88.2%; 95% CI 65.7-96.7%) had a measurable AMT or PMT perforator. Conclusions: Archived CTA demonstrates substantial regional and bilateral variability in thigh perforator measurability. The three-territory comparison provides anatomical information that may inform individualized preoperative assessment, while the exploratory laterality findings require confirmation using standardized acquisition and reproducibility testing.