Multiple arteriovenous communications in the hand usually have their origin in congenital remnants of the embryonic anlage of the arteries and veins. However, such abnormal communications may also develop from the normal arteriovenous communications which occur in the hand and are known as the neuromyo-arterial glomus. In this event, this structure apparently becomes uncontrolled as a result of damage. In one of the three cases reported here, arteriovenous fistulae developed in a finger after a burn became infected. This may be an example of the latter type of pathogenesis.

The diagnosis of congenital arteriovenous fistulae is best made by the arteriogram, since it shows the site of the abnormal communications. The operative procedures for the eradication of these minute anastomotic channels must accomplish this end with the least possible sacrifice of the function of the hand. The excision must be staged, in some instances, to allow adequate collateral circulation to develop between stages. Excision of the skin overlying the lesions, with replacement by pedicle or other types of skin graft, may be necessary in order to excise all communications. The operations are best carried out under tourniquet. A postoperative arteriogram provides the best evidence of adequate excision.

There was no indication in the three cases reported that surgical intervention caused the process to extend into areas where a normal vascular tree existed. One case has been followed for four years without evidence of recurrence.

Excruciating pain in an area of ulceration was a constant finding in the three patients and this was not relieved until healing had occurred.

Although it may not be possible to eradicate every one of the tiny arteriovenous communications in a given patient, in most instances where the process is localized they can be eradicated sufficiently to allow healing to take place and to prevent progressive gangrene and loss of function of the hand.

It is of utmost importance to recognize the clinical entity early and to institute radical surgical treatment before the process causes irreversible changes in the extremity. In one of the patients described, such an irreversible change had taken place and an amputation of the involved finger was neccessary. In the other two cases, adequate excision preserved the remaining hand function.