Entering with the Kleinsasser tube size B. Inspection of the tumor. The central ulcer is visible, which is very deep and extends towards the submandibular region and pharyngeal wall. Inspection of the overlying tonsil. Suspicious tumor foci are now also visible in the middle to upper tonsil region. Overall confirmation of the tumor with a slightly wider extension in the direction of the tonsil lobe. Therefore flap coverage probable. Initially start with transoral resection. Tumor is incised on all sides from the cranial side with a safety margin of 1-1.5 cm. The entire tonsil, the anterior palatal arch and the mucosa of the glosso-alveolar junction are exposed. Resection is performed until there is no longer an overview downwards. Subsequent repositioning for neck dissection and completion of the tumor resection: skin disinfection. Injection of 10 ml Ultracaine 1 % with adrenaline into both sides of the neck. First start with neck dissection on the right: incision in typical manner. Exposure of sternocleidomastoid muscle, omohyoid muscle and digastric muscle. Exposure of the internal jugular vein, facial vein, middle jugular vein, internal carotid artery, external carotid artery, facial artery, superior thyroid artery and lingual artery. Exposure of the hypoglossal nerve, vagus nerve and accessorius nerve as well as the branches of the cervical plexus. Clearing of levels II to V. Submandibulotomy is then performed. The Wharton's duct is exposed and ligated. The lingual nerve is preserved. Cut through the digastric and styloid muscles, which are knocked aside after bipolar coagulation. Then loop the external carotid artery with a vessel loop and dissect the large vessels from the pharyngeal wall. The hypoglossal nerve is completely dissected and mobilized. Then complete the tumor resection from the transcervical side: enter the pharyngeal wall from the inside and outside. Further isolation of the tumor until it can be pulled outwards through the pharyngeal wall. Resection of the tumor together with the large ulcer under visual control. For this, parts of the pharyngeal wall up to the hypopharyngeal entrance, vallecula and base of the tongue must be resected from the right side. Resection is performed anteriorly up to the pre-epiglottic fatty tissue. Tumor is removed in its entirety and thread-marked both circumferentially and basally. Tumor goes to frozen section. In the frozen section, all margins are tumor-free, thus R0 resection. Careful hemostasis and irrigation of the wound area. Neck dissection on the left follows (dictation <CLINICIAN_NAME>): Skin incision along the anterior border of the sternocleidomastoid muscle. Exposure and ligation of the external jugular vein. Exposure and sparing of the auricularis magnus nerve, exposure of the digaster muscle of the cranial accessorius nerve and the caudal omohyoid muscle. Exposure of the capsule of the submandibular gland and the hypoglossal nerve. Subsequent exposure of the internal jugular vein from caudal to cranial. Dissection of the anterior neck specimen with targeted hemostasis and then, starting in level IIb, dissection of the neck specimen with identification and protection of the accessorius nerve and targeted bipolar coagulation. Thus evacuation of levels II, III, IV and V while leaving the submandibular gland intact. Wound irrigation using hydrogen peroxide and Ringer's solution Insertion of a 10-gauge Redon drain and two-layer wound closure in the typical manner using 4-0 Vicryl and 4-0 Ethilon. Transition to tracheostomy: make a 5 cm incision horizontally below the cricoid cartilage and sharply cut through the skin and subcutaneous tissue using a 15 mm scalpel. Further dissection in depth using pointed scissors, anterior jugular vein is identified, cut and ligated, no bleeding. Now locate the anterior neck muscles and cut through the linea alba. The musculature is pushed to the side, the thyroid gland is no longer present during deep dissection, as a complete thyroidectomy was performed years ago. There also appears to be no residual tissue. The trachea is relatively ossified. After demonstrating the findings on <CLINICIAN_NAME>, the 2nd and 3rd tracheal rings are identified and the pointed scissors are used to enter between them. Creation of a Björk flap, targeted bipolar coagulation and placement of 3 sutures using Ethibond caudally and 3 sutures cranially to ensure adequate epithelialization. The skin is movable so that tension-free suturing can be performed without any problems. Skin suture then with 4-0 Ethilon. A 9-gauge cannula is inserted without any problems, cannula change on the 5th postoperative day and suture removal between the 7th and 10th postoperative day. Then removal of the radial flap from the left forearm: After measuring the defect size and the 3-dimentional configuration, mark the flap on the left forearm. Then lift the flap first ulnarly, then radially subfascially. Extend the incision cranially and expose the superficial venous system or the connection to the pedicle. Then clamp the artery. After sufficient time, sever the artery. Saturation always at 100 %. Lift the flap from the lower surface. Outgoing vessels are bipolarly coagulated or clipped. Two larger veins from the superficial venous system can be visualized in the antecubital fossa; the confluent veins are very small. Deposition of the flap with ligation of the veins and suturing of the proximal radial artery. The flap is then flushed with heparin. Closure of the forearm: this is done with split skin taken from the thigh in the typical manner. Hydrocolloid dressing is then applied here. Subsequently, closure of the upper arm proximal primary. This is done after sufficient hemostasis. Sewing the split skin successively into the defect. Sew on a few swabs to ensure fixation of the skin to the wound bed. Then application of octenidine gel. Application of Mepilex. Compressor pressure bandage over this. This is molded to the forearm with absorbent cotton. Then fit a Cramer splint in the functional position. This is fixed with an elastic bandage. Attachment of the forearm. The flap is then sutured into the defect. This is splinted transcervically and transorally, partly with the sutures in place. The flap is successfully sutured into place without tension. Complete defect coverage. The superior thyroid artery is then selected for the arterial anastomosis. This is conditioned, as is the radial artery. Suturing is performed with 8-0 Ethilon single-button sutures. Opening of the clamps, good arterial flow, good venous return. The veins are then conditioned. Here selection of 2 outlets from the thick facial vein. An outlet near the outlet of the facial vein from the internal jugular vein is anastomosed with Coupler 3.0 with one of the cephalic veins after conditioning of the veins. Good venous flow after opening the clamps. Positive smear phenomenon. The other vein from the cephalic area is anastomosed with the stump of the facial vein using Coupler 3.0. Again, good venous flow after opening the clamp, positive smear phenomenon. Subsequent careful hemostasis. Irrigation of the wound area. Closure of the wound in layers and insertion of 2 flaps on the right and a Redon drain on the left. Insertion of a 9 mm tracheal cannula, which is fixed with sutures. The flap is then checked again enorally, which shows the flap to be vital and well supplied with blood. Completion of the procedure without complications. The patient is admitted to the intensive care unit for postoperative monitoring and should remain ventilated for one night. Please continue antibiotics with Unacid for one week. Please check flap perfusion directly transorally or via Doppler at the marked site. This for 5 days. As the patient requires full heparinization postoperatively, the heparin perfusor should be run according to the coagulation situation, between 500 and 1000 E/h depending on the coagulation value. Heparinization is absolutely necessary due to pre-fibrillation. Feeding via the inserted PEG tube. On the 10th day, swallow porridge and then build up the diet if necessary. If necessary, initiation of swallowing training as the defect extends to the vallecula on the right side. Overall cT2-3 oropharyngeal tumor on the right, more likely cT3, clinically enlarged lymph nodes were visible on both sides of the neck. Waiting for the final histology and discussion of further therapy in the interdisciplinary tumor conference.