Patient with Psychosis Undergoing Cheek Reconstruction

managed a patient with amphetamine-induced psychosis. A 30-year-old male with a defect on his left cheek was admitted to the emergency room. He had mutilated himself with a pair of scissors, and was suspected of abusing the substance methamphetamine (Philopon). He was in a drowsy mental state without any aggressive behavior, so there was no need to administer antipsychotics. Based on a physical examination, a 4 cm × 5 cm buccal defect involving the oral commissure and the intraoral lining was observed at the left hemiface (Fig. 1). The facial and neck computed tomography showed no evidence of a fracture or a vascular injury, but it did show signs of a diffuse subcutaneous emphysema around the left buccal area. The patient was referred to the neuropsychiatry department so that his depression and psychosis could be properly evaluated. Psychiatrists and nurses observed his behavior in an isolated psychiatric ward. The psychiatrists performed an accurate assessment of his psychiatric problem. After five days of psychiatric management, his suicidal and psychotic tendencies had decreased. The next day, a microsurgical operation was carried out for cheek reconstruction. Doppler ultrasound was used to check the radial artery, followed by an Allen test before the operation. The bilobed flap is designed to be placed on the volar side of the left forearm, based on the radial artery. One lobe of the flap is used for the reconstruction of the intraoral lining, while the second lobe is used to restore the outer surface of the buccal defect. The size of the flap was 8.5 cm × 5 cm, including the subcutaneous fat (Fig. 2). One radial artery and one radial vein were preserved. The length of the pedicle was 6 cm. When the flap was positioned at the recipient site, the flap was folded to correspond to the dissection margins of the recipient site. One facial artery and Patient with Psychosis Undergoing Cheek Reconstruction