Introductory consultation with the anesthetist. Induction of anesthesia. Intubation by the anesthesia colleagues. Sterile washing and draping. Entering with the tonsil retractor and inspection of the tumor region. The tumor moves from the uvula to the soft palate on both sides. On the right side, the tumor continues caudally towards the lateral wall of the oropharynx as well as the anterior and posterior palatal arch and the upper pole of the tonsillar lobe. The tumor is now incised using a monopolar needle and a safety distance of 1-1.5 cm. Further dissection with bipolar forceps and scissors so that the entire tumor could be resected en bloc. The tumor is thread-marked for frozen section. All edges are tumor-free in the frozen section. Measurement of the defect, 8 x 6 cm with a protruding boundary for the tonsil lobe on the right side. Perform esophagogastroscopy. After a positive diaphanoscopy, PEG placement using the thread pull-through method. Dressing application. Perform neck dissection in parallel on the left and right. To do this, make a skin incision in the usual manner on the anterior edge of the sternocleidomastoid muscle with a medial bulge. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Showing the submandibular gland. Exposure of the cervical vascular sheath. Dissection of the internal jugular vein, the facial vein and the external jugular vein. Exposure of the accessorius nerve and hypoglossal nerve. Displacement and, at the end of the operation, re-embedding of the accessory nerve and hypoglossal nerve in the sense of a neurolysis. Exposure of the vagus nerve. Displacement and, at the end of the operation, re-embedding of the vagus nerve in the sense of a neurolysis. Clearing of neck levels IIa to Va while sparing the plexus branches. Clearing of neck levels Ia and b with exposure of the oral branch. Identical procedure on the left side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the cervical vascular sheath. Dissection of the internal jugular vein. Exposure of the hypoglossal nerve and accessorius nerve. Displacement and, at the end of the operation, re-embedding of both nerves in the sense of a neurolysis. Clearing of the neck levels II a to V a while sparing the plexus branches. Creation of a tunnel on the right to the tonsillar lodge on the right for the subsequent flap pedicle. Lifting the radialis graft. Marking of the graft. Cutting around the graft. Exposure of the brachioradialis muscle. Exposure of the cephalic vein. Exposure of the venous confluence between the superficial and deep venous system. Visualization of the external ramus, the radial nerve. Exposure of the radial artery. Clamping and ligation of the radial artery. Removal of the graft from the sutures and dissection of the pedicle up to the elbow. The pedicle is placed in such a way that the interosseous artery and the ulnar artery can be preserved. Two superficial veins and one deep vein are prepared for the connection. The graft is then flushed with heparin to ensure good reflux from the veins. The graft is sutured transorally. The back surface of the soft palate is fixed first. The flap is then folded and the anterior surface reconstructed. Finally, the tonsil lobe is reconstructed. The stalk must be pulled through the opening between the tonsil lobe and the neck. To do this, the tunneling had to be widened slightly. The stalk can now be positioned in the neck and anastomosed with the superior thyroid artery. The deep vein is anastomosed with an outlet from the facial vein and the two superficial veins are anastomosed with the external jugular vein and an outlet from this. Very good graft perfusion at the end. Due to the very far cranial location of the tumor and the low risk of secondary bleeding, a tracheotomy is not initially performed. Two-layer wound closure after insertion of a Redon drain on the left side. Insertion of a flap on the right side. Application of a pressure bandage on both sides. The left forearm was covered with split skin from the right thigh. To do this, lift the split skin using a dermatome (7.5 cm) on the thigh. This skin is then fitted to the forearm defect and fixed using single button sutures. Preparation swabs are sutured centrally in the split skin area so that the split skin has contact with the undersurface everywhere. Now create small slits in the split skin. Finally, compression is sutured onto the forearm as large-area compression. Then absorbent cotton dressing, followed by application of a dorsal forearm splint (Cramer splint) using an elastic bandage. Dressing of the thigh using Mepilex. Final consultation with the anesthetist. The patient goes to the intensive care unit intubated and ventilated. Please continue postoperative antibiotics. Presentation of the patient in the tumor conference after receipt of the histology. Regular flap checks according to the usual schedule.