Induction of anesthesia and intubation by anesthesia colleagues. Sterile washing and draping of the abdominal area. Placement of a PEG using the thread pull-through method with good diaphanoscopy without any problems. Injection in the neck and sterile washing and draping. Insertion of the mouth blocker and start of transoral tumor resection. There is an exophytic mass in the tonsil lobe, which passes over the glossotonsillar groove to the base and edge of the tongue and the floor of the mouth on the right side. Start of tumor resection in the area of the soft palate with the electric needle. Dissection up to the tonsil bed. The soft tissues of the throat are reached relatively quickly here. Dissection up to the base of the tongue and dissection at the edge of the tongue. Ultimately, the tumor cannot be completely removed transorally, so it is transferred for neck dissection. Creation of an apron flap in the usual manner. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the digaster and the submandibular gland. Exposure of the cervical vascular sheath and the accessorius and hypoglossal nerves. Then evacuation of the neck levels I b to V a while sparing the plexus branches. Removal of the submandibular gland. Cut through the digastric muscle and enter the oropharynx. Now pull through the tumor and complete the tumor resection from transcervical. Remove marginal samples and send the specimen on cork for histology. All marginal samples are free of tumor and carcinoma in situ. Moderate dysplasia was found in the soft palate area. Further resection is recommended here. This is carried out and sent for final histology. Finally, clearing of level I a on the right side. Neck dissection on the left and tracheotomy by <CLINICIAN_NAME>. Exposure of the anterior border of the sternocleidomastoid muscle and exposure of the omohyoid muscle. Dissection of the omohyoid muscle to the cranial side of the digaster muscle. Exposure of the accessorius nerve. Locate the submandibular gland and expose the gland. Fold up the gland and expose the digaster muscle. Dissection in the direction of the hyoid bone and mastoid. Dissection of the internal jugular vein. Free dissection of the vein from caudal to cranial. Easy dissection and visualization of the facial vein. Locating and preserving the hypoglossal nerve at the jugulofacial angle. Careful removal of the medial neck preparation while preserving all structures. Dissection of the lateral neck preparation and removal of this while preserving the plexus branches. No increased bleeding, no chyle. Tracheotomy: Marking of the landmarks and dissection through the prelaryngeal muscles in the linea alba onto the cricoid cartilage. Push the prelaryngeal musculature to the side. Exposure of the thyroid gland and undermining of the thyroid gland with the Pean clamp. Bipolar coagulation of the thyroid gland and careful transection of the thyroid gland. Move the thyroid gland to the side and expose the trachea. Opening of the trachea between the 2nd and 3rd interspace. Entering the trachea and creating a Björ flap. Suturing of the tracheostoma at the caudal edge. Now hand over the operation to the reconstruction team with <CLINICIAN_NAME>. First measure the required dimensions of the flap, these are max. 12 cm long and 10 cm wide. The flap is then raised on the radialis flap on the left forearm: Mark the flap dimensions according to the required size and three-dimensional configuration. Then recut the flap, initially ulnarly. The incision is extended in the direction of the ulnar flexion. Exposure of the superficial venous system, which is integrated into the flap. Lift the flap initially from the ulnar side. Subsequent incision also from the radial side with subfascial and ulnar elevation of the flap. The lateral antebrachial cutaneous nerve is exposed and preserved as far as possible. Distal exposure of the radial artery, which is clamped off. .................................. Lateral exposure of the superficial venous system up to the crook of the elbow. This shows the cephalic vein with two good ends, a good connection to the deep venous system. Depiction of the deep venous system. Exposure of the vascular pedicle. Subsequent transection of the radial artery with good saturation. This is treated proximally and distally with 4.0 Prolene single-button stitches. Lift the flap subfascially. Outgoing vessels are coagulated or clipped. Dissection up to the crook of the elbow. After clamping, cut the interosseous artery. Exposure of the venous confluence, which is lifted with a total of 2 ends. The veins, which are ligated, are then removed and the artery, which is supplied with a 6.0 Prolene suture in the area of the end of the brachial artery, is removed. Flush the flap with heparin solution. Subsequent insertion of the flap into the defect. Successive suturing of the flap, first from the transcervical and then from the transoral side, partly with the sutures in place using 3.0 Vicryl single-button sutures. The result is a tension-free, complete and anatomically correct reconstruction. Flap pedicle is prepared. The radial artery and 2 ends of the cephalic vein are conditioned, as are the superior thyroid artery, the middle thyroid vein and the external jugular vein. The arteries are sutured using 9.0 Ethilon single-button sutures. The veins are anastomosed using 3 and 2 couplers. Positive smear phenomenon after opening the clamps. Arterial flow after opening the clamp before the vein anastomosis is also regular. Subsequent careful irrigation of the wound area and hemostasis. Wound closure of the neck sides is carried out by suturing the skin on the tracheostoma area and inserting Redon drainage on the left and 2 flaps on the right. The cannula is fixed with sutures. Flap vital after repeated transoral inspection. Completion of the procedure without complications. Patient goes to the intensive care unit for postoperative monitoring. Please continue the antibiotic treatment with Unacid for 1 week. Nutrition via the inserted PEG tube until the 7th-10th day, then gruel and, if necessary, diet build-up. Regular checks of the flap perfusion clinically or via the Doppler in the neck area in the area of the marking threads. Checks according to the schedule for 5 days. Wait for the final histology and presentation at the interdisciplinary tumor conference.