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Surgical Specialist, Plastic Surgery Specialist
46 years of experience


Education ?

Medical School Score Rankings
University of Michigan Medical School (1966)
Top 25%

Awards & Distinctions ?

American Board of Plastic Surgery

Publications & Research

Dr. Markley has contributed to 12 publications.
Title The Fibonacci Sequence: Relationship to the Human Hand.
Date December 2003
Journal The Journal of Hand Surgery
Title Transplantation and Transposition of Skeletal Muscles into the Faces of Monkeys.
Date September 1989
Journal Plastic and Reconstructive Surgery

Restoration of normal facial movement after long-term facial paralysis with muscle atrophy has not yet been achieved reliably by either free grafts, in which fibers degenerate and regenerate, or by grafts made with microneurovascular repair, in which most fibers survive. Our purpose was to compare the structural and functional properties of free muscle grafts and continuously perfused muscle flaps transplanted into the faces of monkeys. In adult monkeys, the facial muscles were replaced by either a free graft of a donor muscle from the lower limb or a denervated flap of ipsilateral temporalis muscle. Each graft or flap was reinnervated with the preserved buccal branch of the facial nerve. The control muscles, grafts, and flaps were examined 90 days later for gross appearance, contractile properties, and fiber areas. Compared with muscle flaps, free grafts showed greater adaptability to the new location and innervation and a closer approximation to the structural and functional properties of the original facial musculature.

Title Lentoid.
Date February 1988
Journal Plastic and Reconstructive Surgery
Title On Curves and Spirals.
Date April 1987
Journal Plastic and Reconstructive Surgery
Title Island Flaps of the Hand.
Date April 1986
Journal Hand Clinics

This article discusses the use of vascular island skin and composite flaps in surgery of the hand. The history of the development of island flaps is outlined. The principles, indications, and techniques for several useful island flaps in the hand are presented.

Title Functional Properties of Palmaris Longus Muscles of Rhesus Monkeys Transplanted As Index Finger Flexors.
Date October 1985
Journal Plastic and Reconstructive Surgery

This experiment with skeletal muscle autografts in monkeys was designed to retest previous findings that transplanted skeletal muscle can regenerate to a functional degree in primates without predenervation and to test a new hypothesis that increased functional demands on regenerated muscle grafts in monkeys may result in improved functional capacity of the grafts. Rhesus monkey index flexors were replaced with free palmaris longus muscle autografts with microneural anastomoses between the graft motor nerve and the severed profundus motor nerve. One monkey was taught selective index flexion before grafting and continued with this program after grafting to test the effect of training on the graft. Mature grafts were evaluated for in vivo contractile properties and by histology and histochemistry and were compared with a group of normal Rhesus palmaris longus muscles. The results reconfirm the capacity of nonpredenervated monkey skeletal muscle grafts to regenerate and to achieve some contractile ability and suggest that training of free muscle grafts may enhance recovery of their functional and structural properties.

Title More on Painful Neuromas.
Date September 1983
Journal The Journal of Hand Surgery
Title Characteristics of Cat Skeletal Muscles Grafted with Intact Nerves or with Anastomosed Nerves.
Date July 1983
Journal Experimental Neurology

Grafting of 3-g extensor digitorum longus (EDL) muscles of cats may be made with (i) severence of the nerve with spontaneous reinnervation, termed standard grafts (ii) severence of the nerve with reinnervation facilitated by anastomosis of the nerve, termed nerve-anastomosed grafts; and (iii) preservation of the nerve, termed nerve-intact grafts. In previous studies, standard grafts developed a maximum isometric tetanic tension (P0) that was 22% of the value for control EDL muscles. We hypothesized that the low values of P0 resulted from incomplete reinnervation of muscle fibers. To test this hypothesis, EDL muscles were grafted in cats with nerves intact and with nerves anastomosed. In standard grafts differences were observed in both structure and function at 120 compared with 240 days after grafting. Characteristics of the nerve-intact and nerve-anastomosed grafts did not change significantly between 120 and 240 days and the data were pooled for comparisons with control EDL muscles. Nerve-anastomosed and nerve-intact grafts developed P0 values that were 34 and 64% of the control values, respectively. Nerve-intact grafts had a mass and fiber cross-sectional area not different from control EDL muscles. Compared with control values, all grafts had fewer fibers, more connective tissue, lower absolute and normalized P0, reduced capillary density, and increased fatigability. The greater P0 of nerve-intact compared with standard and nerve-anastomosed grafts supported our hypothesis that the degree of reinnervation is a factor that limits graft development. The presence of a necrotic core and the low tension development of even the nerve-intact grafts suggested that revascularization is a significant limitation as well.

Title Translocation of the Temporalis Muscle for Treatment of Facial Paralysis.
Date January 1983
Journal Muscle & Nerve

Our purpose was to characterize in the rhesus monkey the structure and function of vascularized temporalis muscle flaps innervated by the facial nerve after translocation into the site of the denervated zygomaticus muscle. Animals were killed at 28 to 120 days following translocation. Control data were obtained from the contralateral side. Twenty-eight days after translocation, the time to reach peak twitch tension and one-half relaxation time were 170% of control zygomaticus muscle. Contraction times decreased with time and reached control values by 100 days. Absolute isometric tetanic tension was not different between the flap (4.29 +/- 1.28 newtons; X +/- SEM) and control zygomaticus (3.95 +/- 0.80 newtons). Succinate oxidase activity of the flap decreased from 279 +/- 18 nl O2/mg protein/min to control zygomaticus values (98 +/- 18) by 110 days. The type 1 fiber cross-sectional area of the flap was 52% of control temporalis muscle and 150% of control zygomaticus muscle (P less than 0.05). The temporalis flap demonstrated viable structure and function and appeared useful in facial movements.

Title Neuroanastomosis of Orthotopically Transplanted Palmaris Longus Muscles.
Date July 1980
Journal Muscle & Nerve

Palmaris longus (PML) muscles of rhesus monkeys were transplanted, with or without anastomosis of the median nerve, to the nerve stump of the autograft. Because PML autografts revascularize spontaneously, vascular anastomoses were not performed. Muscle fibers regenerated in all autografts with neuroanastomosis, but in only three of eight autografts without neuroanastomosis. Five autografts without neuroanastomosis were replaced by noncontractile connective tissue. Growth and differentiation of muscle fibers into three fiber types and development of capillarity were analyzed histochemically, and succinate oxidase activity of whole-muscle homogenates was determined. None of these measures reached values for control PML muscles within 100 days of transplantation. In comparison to control muscles, autografts had slower times to peak tension and less absolute tension, but similar tension per square centimeter of muscle fiber cross-sectional area. Monkey PML autografts with neuroanastomosis were similar in structure and function to cat extensor digitorum longus autografts that had not had neuroanastomosis.

Title Regeneration of Skeletal Muscle After Grafting in Monkeys.
Date November 1978
Journal Plastic and Reconstructive Surgery

Twenty-five palmaris longus muscles were transplanted into the forearm (orthotopic autografts) or into the face (heterotopic autografts) in 15 Rhesus monkeys. These muscles were transplanted with or without anastomosis to a motor nerve. No significant difference was observed long-term between the grafts done with or without prior denervation of the muscle. The forearm muscle grafts without neurorrhaphies formed a static, fibrous sling which did not contract. The forearm autografts with neurorrhaphy and the grafts to the face, with or without neurorrhaphy, all developed regenerating skeletal muscle fibers and showed contractile activity.

Title The Preservation of Close Two-point Discrimination in the Interdigital Transfer of Neurovascular Island Flaps.
Date June 1977
Journal Plastic and Reconstructive Surgery

Some possible reasons for the reported failures of digital neurovascular island flaps to provide normal (or near normal) tactile sensibility are discussed. Some technical variations which may improve the results are proposed. An illustrative case is reported in which there was transfer of intact two-point discrimination.

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