Advancing Plastic Surgery Practice and Research

(April 10, 2018) — When most people think of plastic surgery, they think of cosmetic procedures. For David Habin Song, MD, MBA, the field is much more than that, including saving limbs damaged by diabetes and using the most advanced techniques to help women who have had their breasts removed in the course of cancer treatment.

Song currently serves as academic chair of the department of plastic surgery at Georgetown University School of Medicine and MedStar Health physician executive director for plastic surgery, which encompasses plastic and podiatric surgery, as well as MedStar Georgetown University Hospital’s Center for Wound Healing/Limb Salvage and all of the MedStar Health Wound Healing Centers. In his year in those positions, Song has turbocharged the role of plastic surgery in MedStar Health’s regional academic health system.

“My mission is to create the best academic health system in the country for these service lines. To that end, we have really bolstered our clinical presence, and our academic research portfolio has been enhanced as well,” Song says.

With MedStar Health as Georgetown University Medical Center’s clinical partner, the two institutions build on each other’s strengths. GUMC provides a strong academic and research mission with dedicated faculty while MedStar provides the incubator that allows that research to support innovations in health care delivery. With both, the ultimate beneficiary is the patient.

In the plastic surgery department that Song oversees, peer-reviewed research publications grew by 25 percent in the last year alone. Additionally, he has created a vice-chair for research position. The number of Georgetown medical students who chose to pursue plastic surgery increased in 2018, reflecting a positive engagement with Song and his team. MedStar’s residency in plastic surgery has expanded from three residents per year to four, and there are more competitive applicants for the residency positions, Song says. “We have integrated the service lines for education and research across all of MedStar Health with Georgetown being the anchor of the academic enterprise,” he adds.

Developing expertise in microsurgical techniques

Clinically, Song is diving deep into a wide scope of plastic surgery techniques. “Plastic surgery is a field that covers the entire body, from scalp and cranial reconstruction to limb salvage,” he says. “The hospital’s Center for Wound Healing, for example, is a world leader in saving limbs in patients who have diabetes.”

What the limb salvage center has in common with the latest plastic surgery techniques — some of which have been advanced or pioneered by Song himself — is microsurgery that reaches the level of individual blood vessels and nerves. It takes a “disciplined set of tools” and an additional year of training to really get comfortable sewing little blood vessels under a microscope with sutures that are about half the thickness of a human hair, he says.

Research is the key to progress, and plastic surgery patients at MedStar will have the opportunity to participate by enrolling in multicenter clinical trials. The patients will also be longitudinally followed for their outcomes, Song adds. “We want to serve a wide swath of patients that spans from Baltimore all the way down to southern Maryland to investigate things like diabetic foot healing, function after amputation, breast reconstruction and outcomes, and patient reported outcome measures.

“There are a whole host of clinical and research investigations that are amenable to a large health system.”

Finding joy “in restoring something that cancer or trauma has taken away”

Song can also suture nerve fibers together — the final step in re-creating a breast that looks and feels natural. Other MedStar physicians are using or learning that technique. He is a well-known leader in the use of microsurgical techniques to help women who have had breast removal and/or excision of lymph nodes to treat breast cancer. Song learned to use a patient’s own skin, tissue, fat and blood vessels to restore breasts when he was at the University of Chicago Pritzker School of Medicine.

“In my early career there, I did a lot of laboratory-based biomechanical work, where we came up with a lot of innovative ways to reconstruct the chest wall and even breast reconstruction,” says Song, who graduated from medical school at UCLA before joining the University of Chicago for a fellowship, internship, residency and a faculty position. He left in early 2017 as chief of plastic and reconstructive surgery and associate dean to join MedStar. His research focus was on outcomes in both breast reconstruction and chest wall reconstruction.

Song estimates that he has reconstructed several thousand breasts to be as natural as possible. At MedStar, he does about four breast reconstruction surgeries a week, a procedure that takes about 4.5 hours. “It is my understanding that in the greater D.C., Maryland and Virginia area, we are the leaders, in volume, of breast reconstruction,” he says.

Song is also leading an effort to expand use of lymphovenous bypass and lymph node transplant.

“One of the biggest side effects of breast cancer surgery is lymphedema, painful swelling of the arm caused by the removal of lymph nodes under the arm. Because these little pumps are not there to remove lymph fluid, the arm can swell intolerably,” he says. The answer, Song says, is to transplant “excess” lymph nodes from another part of the body to the armpit area, and connect them so that they can drain lymph into an existing blood supply.

“This is a burgeoning field because the procedure can be used in many areas of the body,” Song says. “There is such great pleasure in restoring something that cancer or trauma has taken away.”

Cost containment as a sign of quality

And, as at the University of Chicago, where he earned an MBA from the Booth School of Business, Song is keenly interested in improving health care delivery. “I blend a lot of operations management in health economics into how we practice medicine today,” he says.

Among his ongoing projects is reduction of medical waste in surgery and improvement in the ergonomics in surgical practice.

Song is also leading an effort to reduce health care costs “as a proxy for quality health care.”

“A large theme of how we practice surgery in the department of plastic surgery here is looking at cost containment — how we can make things more efficient and at the same time create a higher quality of care that is delivered.”

Song is interested in increasing health care value by exploring bundled payment for a particular surgery. “If there are complications, that will be a cost to us,” Song says. “This system is very attractive to both payers and to patients because it shows that you take reduction of complications to a higher level and thus are more focused on preventing them.”

He believes such goals are welcomed at Georgetown and MedStar Health. “My collaborators and teammates — the environment as a whole — have been absolutely welcoming and the intellectual curiosity amongst my colleagues has been something that is quite refreshing,” Song says. “Our approaches, and aspirations for a fine, state-of-the-art academic health system, match beautifully.”

Renee Twombly
GUMC Communications