This page gives an overview of the Dermatology and Occupational Therapy Departments at Great Ormond Street Hospital (GOSH). It provides information on one of the conditions treated, venous malformations and details how the department measures the patient and or parent reported outcomes for treatment with compression garments.
Overview of dermatology and occupational therapy
The Dermatology Department at GOSH offers a broad range of services for paediatric patients with severe skin disorders.
The dermatology team see around 4,000 children each year as outpatients. Last year, the team saw about 280 children as inpatients and 400 as day patients.
The dermatology team diagnose and treat children with a number of conditions including birthmarks; complex vascular malformations; severe eczema; severe psoriasis; epidermolysis bullosa; ichthyosis; morphoea; disorders of pigmentation and proteus syndrome.
The dermatology team consist of doctors, nurses, occupational therapists and physiotherapists who work together to treat children. As a specialist children’s hospital they tend to see children who have already been seen at their local hospital.
Children are referred to the team by local hospital consultants, community paediatrics or in certain circumstances via a GP.
Occupational therapy minimises the impact of disease and disability through the use of purposeful activity. Occupational therapy is available to patients treated in many different clinical areas including
- neurology and neurosurgery
- haematology and oncology
- plastics and dermatology
One the conditions treated by dermatology and occupational therapy is venous malformation. The following section details information on this condition, treatment and results of treatment.
Venous Malformation Service
Venous malformations are abnormalities affecting blood vessels that occur during the development of a baby.
Venous malformations usually look like soft, lumpy, blue marks on the skin. They are present at birth, although they may not be obvious until the child grows. They grow in proportion with the child but may increase in size as a child puts on weight, if the malformation is traumatised or when hormone levels rise.
We do not yet know what causes vascular malformations, although we are sure that it is not linked to anything that happened or did not happen during pregnancy.
Venous malformations are assessed and treated by a team of specialists including paediatric dermatologists, radiologists, plastic or vascular surgeons and occupational therapists.
Venous malformations are generally evident upon physical examination. They are diagnosed from scans in the Radiology Department. For example, an ultrasound scan show us the blood flow through the veins, as well as any clots, and an MRI scan shows us the extent of the malformation and which parts of the body are involved.
At GOSH, we tend to see children with the more severe malformations and we have treated over 250 such children in the past 15 years.
The options for treatment depend on the size and location of the malformation and the blood vessels involved. Some or all of the following options are possible:
- laser therapy
- surgical removal
Most children treated at GOSH are now leading fulfilling lives, attending college and working.
The information below is from results from patients that have been treated for venous malformations by using compression garments.
How do we measures the results of venous malformation treatment?
A great proportion of patients treated for venous malformation at GOSH use compression garments. Compression garments are made of closely fitting Lycra® material, which applies a compressive force against the body.
Compression garments are used to reduce pain and swelling allowing a wider range of activity and also improve appearance to an extent. Compression garments work by stopping blood pooling in the abnormal big veins and encourage blood flow to the heart through normal veins. They can also be helpful in making sport and exercise more bearable as they support the malformation and reduce swelling.
In most cases they need to be worn for eight to 12 hours a day to be effective although some patients may just wear them for sport or when symptoms arise.
A patient/parent outcome venous malformation questionnaire was developed to assess if the use of compression garments made a difference to the patients’ management and the side effects of venous malformation.
The questionnaire asked patients or their parents to rate:
- the comfort and appearance of their compression garment
- satisfaction that the garment helped with reduced pain; swelling and blood clots
- satisfaction that the garment helped to increase activity and protect against knocks and bruises
It also allowed them to leave additional comments regarding compression garments.
Patient/parent 0utcome venous malformation questionnaire results
During 2011, the majority of patients that were seen by the occupational therapist were given s questionnaire to complete. In total, 33 questionnaires were completed.
Patients or their parents were asked to score on a scale of one to 10 (with 10 being the most satisfied) how they felt the garments helped with reducing pain, swelling and blood clots and increasing activity and protection against knocks and bumps.
The results show the majority of patients or their parents were very satisfied with the effect of the compression garment on reducing swelling and pain (rating between eight and 10 out of 10).
The results were similar for the effect of wearing compression garments on increasing the patient’s activity.
In addition the results show that 31 out of the 33 patients either liked or thought the appearance of the compression garment was ok. Similarly the same number responded that wearing the compression garment was either comfortable or very comfortable.
The occupational therapist found using this survey really helpful to understand how her patients felt about the compression garments and to ensure she could help improve areas if required.
The team will use these results to inform the fit and design of the compression garments for new patients and to inform new patients and their families of how others have found wearing compression garments and the results on managing swelling and pain and improving activity and protection.
The following section show the results for each area together with the overall proportion of responses grouped into the following categories:
- 1 - 4 out of 10 being least satisfied with the garment helping
- 5 - 7 out of 10 being fairly satisfied with the garment helping
- 8 - 10 out of 10 being most satisfied with the garment helping
The results were also reviewed to see if there was any relationship between the age of the patient and how long they had been wearing the garment.
Reducing swelling results
64 per cent of patients or their parents were very satisfied with the effect of the compression garment on reducing swelling.
The highlights of the results are as follows:
- Nine out of the 33 patients/parents scored 10 out of 10.
- Patients who are aged between 5 and 10 were on average the most satisfied that their garments had helped to reduce swelling.
Reducing pain results
64 per cent of patients or their parents were very satisfied with the effect of the compression garment on reducing pain.
Some highlights of the responses are as follows
- Five out of the 33 patients/parents scored 10 out of 10 and a further eight patients/parents scored nine out of 10.
- Patients who have worn compression garments for less than 12 months were on average the most satisfied that their garments had helped to reduce pain.
Increasing activity results
55 per cent of patients or their parents were very satisfied with the effect of the compression garment on increasing the patient’s activity.
Some highlights of the responses are as follows
- Seven out of the 33 patients/parents scored 10 out of 10
- Patients who have worn the compression garment for two years or more were on average the most satisfied that their garments helped to increase activity.
Increasing protection from knocks and bumps results
47 per cent of patients or their parents were very satisfied with the effect of the compression garment on increasing the patient’s activity.
Some highlights of the responses are as follows
- Five out of 33 patients/parents scored 10 out of 10 and a further five patient/parents scored nine out of 1.
- Parents of children who have worn the garment for less than 12 months were on average the most satisfied that their garments helped to provide protection against knocks and bumps.
Reducing blood clots
Patients and parents found it difficult to answer the question that related to how the garment helped with reducing blood clots as they felt it was difficult to really know if the garment had done this or the medication taken had reduced blood clots.
Therefore the 19 out of the 33 patients/parents responded with either ‘don’t know’ or ‘not applicable’ to this question.
About the information
This information was taken from the results of all questionnaires completed in 2011. Thirty-three responses were collected, of which:
- 14 patients were male and 19 patients were female
- 28 patients wear made to measure garments; three wear ready made and two wear a combination
- 30 patients wear garments during the day and three wear garments both day and night
- 32 patients wear the garments for preventative reasons and a further one patient wear for sports
- 26 patients wear garments every day per week; five wear garments 3 to6 times per week; one patient wears once or twice a week and one patient reported only wearing the garment occasionally
During 2012 the team will revise the questionnaire and attempt to capture opinions before compression garments are provided and after wearing compression garments for a fixed period of time to determine if the patient feels there is an improvement in their condition as a result.
The results of this will be made available in July 2013.