12/28/2016    Don Peacock, DPM, MS

The MIS SERI Procedure (David Cutler, DPM)

I agree with Dr. Cutler’s position on using
well documented procedure technique such as the
SERI technique. However, the SERI technique is
not the only MIS technique which has undergone
research scrutiny.

The Reverdin-Isham has similar data to back it
as well: Bauer T, de Lavigne C, Biau D, De
Prado M, Isham S, Laffenétre O. Percutaneous
hallux valgus surgery: a prospective
multicenter study of 189 cases. Orthop Clin
North Am. 2009 Oct;40(4):505–514.)

The SERI technique is not without some
controversy. The data that is presented by Dr.
Giannini is good and at least one independent
study shows good results as well in a 10 year
followup : Faour-Martin O, Martin-Ferrero MA,
Valverde Garcia JA, et al. Long-term results of
the retrocapital metatarsal percutaneous
osteotomy for hallux valgus. Int Orthop.
2013;37(9):1799–1803.

Keep in mind the SERI is a minor modification
of the original BOSCH procedure and when Gianni
1st performed it he was performing something
new. We can never advance or modify existing
procedures without venturing into unknown
territory to some degree. This is the way
forward and it's want Gianni did and what some
MIS surgeons are doing now.

With respect to objections for the SERI, some
surgeons have concerns over instability issues
since the osteotomy is at the level of the
distal neck and immobilized by a single K-wire
rather than rigidly internally fixed. An
independent radiographic analyses of the SERI
technique failed to reproduce good radiographic
results, even with a second K-wire to transfix
the osteotomy [Huang PJ, Lin YC, Fu YC, et al.
Radiographic evaluation of minimally invasive
distal metatarsal osteotomy for hallux valgus.
Foot Ankle Int. 2011;32(5):S503–S5007.

SERI instability problems led to the a new
technique based on percutaneous techniques but
internally fixed with compression screws – the
above-described MICA technique: Redfern D, Gill
I, Harris M. Early experience with a minimally
invasive modified chevron and akin osteotomy
for correction of hallux valgus. J Bone Joint
Surg Br. 2011;93(Suppl IV):482.

Ironically, this is a percutaneous MICA version
is an Austin/Akin with percutaneous screw
fixation. This leads us full circle back to the
old standard of bunion correction most of us
learned in our residency programs under
traditional paradigms.

The Reverdin-Isham has minimal postoperative
evaluated complications. De Prado who was a
student of Dr. Isham quotes portal burns to be
around 3%. Recurrence of the hallux valgus,
pain and rigidity were also present in 3 to 4%
of the cases with the Reverdin-isham (Minimally
Invasive Foot Surgery, Dr. DePrado).

So far all of these MIS techniques have
resulted in very good outcomes from a
subjective point. The MIS protocols seem to
have the ability to obtain head-to-head results
when compared to traditional procedures. The
MIS techniques have some obvious advantages.
However, from an academic standpoint the
techniques are no better than traditional
techniques. The true MIS advantages are less
pain and swelling for our patients and quicker
recoveries along with less expensive ways to
perform our corrections.

That being said all of these procedures will
need to undergo scrutiny and may never replace
the “ibuprofen of bunion surgery” we call the
Austin. That doesn't mean we should not write
for new NSAIDS with some their potential
advantages over Ibuprofen. I think that Dr.
Laporta said it best in his video on SERI.
Paraphrasing what he said: A bunion procedure
performed well regardless of technique leads to
good results. I could not agree more. I salute
the nice academic post by Dr. Cutler.

Don Peacock, DPM, MS, Whiteville, NC

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