After appropriate preparation, first infiltration with local anesthetic containing adrenaline in the area of the subsequent incisions for neck dissection. Sterile washing and draping. First perform the tracheostomy. Re-intubation of the patient. This is followed by transoral tumor resection. The entire soft palate is removed. Resection begins at the middle tonsil pole on the right side and extends over the soft palate to the opposite side up to the lower tonsil pole. The tumor is not easily visible macroscopically. After removal of the resectate, the complete resectate is sent for frozen section histology. Carcinoma extensions are still found on the left side paramedian, therefore resection on the left side, starting from the paramedian in the area of the posterior palatal arch. These proved to be free of tumor on frozen section histology. Furthermore, an additional marginal incision is made from the anterior resection margin starting in the middle to the left. This is also free of tumor on frozen section histology, so that an R0 resection can be assumed overall. Subsequently, a radial lobe graft measuring 4 x 9 cm was measured and prepared by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Elevation of the radial forearm flap: Palpatory identification of the distal radial artery. Marking of the flap borders (9 x 4 cm) on the distal forearm, proximal to the flexor retinaculum, with an S-shaped incision running proximally into the cubital fossa. Incision of cutaneous and subcutaneous tissue starting proximally. Identification and visualization of the venous confluence in the cubital fossa. Identification of the cephalic vein and dissection of the vein distally with integration into the radial graft margin. Identification of the ramus externus of the radial nerve and elevation of the radial portion, leaving the peritendineum of the tendons of the brachioradialis muscle intact. Subsequent ulnar incision down to the forearm fascia. Incision of the fascia and subsequent subfascial elevation of the ulnar edge of the graft up to the tendon of the flexor carpi radialis muscle. Care is taken to leave the peritendineum on the flexor tendons and to spare the ulnar artery. Identification of the distal radial artery and trial clamping with a vascular clamp. After 5 minutes with good oxygen saturation measured by pulse oximetry (measured on the index finger), the vessels are removed with subsequent ligation (Prolene 6.0). Successive detachment of the flap pedicle from the M. pronator quadratus and M. flexor pollicis longus with ligation of the outgoing perforators using a vessel clip into the cubital fossa. Exposure and protection of the radial nerve on the medial side of the brachioradialis muscle. Exposure of the brachial artery, V. mediana cubiti, A. ulnaris. First removal of the radial artery, then of two veins of the superficial venous system. Vascular ligation by means of a bypass ligature (artery) and vascular clip (veins). Subtle hemostasis in the area of the wound bed using bipolar coagulation forceps. Two-layer wound closure in the area of the proximal forearm. Dissection of a spindle-shaped skin flap from the skin of the proximal forearm, thinning of the skin and suturing in the usual manner to cover the defect on the distal forearm. Application of a forearm splint. Completion of the graft lift without complications. Now perform the neck dissection on the right side. After skin incision and preparation of the cervical vascular nerve sheath, regions II to IV are cleared out while sparing all non-lymphatic structures. Insertion of a Redon suction drain and two-layer wound closure. Transition to neck dissection on the opposite side. In principle, the same procedure is used here. Macroscopically, there is no evidence of lymph node metastasis on either side. Subsequent skeletonization of the hypoglossal nerve and the lingual artery, which will later be used for anastomosis. Creation of the breakthrough into the oropharynx in the lower left tonsil bed. After removal of the radial artery flap graft, it is inserted through the defect into the pharynx and sutured in place The flap is doubled in the middle. The arterial anastomosis of the strong forearm artery on the lingual artery is then performed on the right side. The venous anastomoses are two pieces in an end-to-side manner to the internal jugular vein. Finally, insertion of a Redon suction drain and a drainage flap in the usual manner. Two-layer wound closure. End of the operation, transfer of the patient to anesthesia after placement of a transverse gastric tube, the correct position of which is confirmed by auscultation. Conclusion: Transoral soft palate resection for soft palate carcinoma with primary reconstruction of the microvascular anasatomized radial flap graft from the left forearm. Covering of the defect on the left forearm with full-thickness skin from the same side of the forearm, arterial anastomosis to the lingual artery and two end-to-side veins to the internal jugular vein. Passenger tracheostomy.