After appropriate preparation, the PEG is first placed by <CLINICIAN_NAME>/<CLINICIAN_NAME>: insertion with the gastroesophagoscope under air insufflation. Pre-insufflation into the stomach. After spontaneous diaphanoscopy, placement of a PEG tube with a thread pull-through method in the typical manner, no complications. The patient received 3 g Unacid i.v. perioperatively. Subsequently, infiltration of the subsequent apron flap incision with local anesthetic containing adrenaline. Sterile washing and draping. Marking and incision of the apron flap, which is lifted subplatysmal to the hyoid bone and fixed cranially in the usual manner. Then start with the right side. After identifying and opening the cervical vascular nerve sheath, regions II to V are successively removed. All non-lymphatic structures of the accessorius nerve, hypoglossal nerve and vagus nerve are spared and preserved. After evacuation of levels II to V and skeletonization of the carotid artery, the supralaryngeal vascular nerve bundle is severed. The insertions of the pharyngeal muscles are then separated from the lateral thyroid cartilage and the piriform sinus is released. Prior to this, the right thyroid lobe is ligated in the area of the isthmus and dislocated to the side. This also exposes the upper trachea. Then transition to the opposite side. In principle, a similar procedure is carried out here with the same findings. After separation of the pharyngeal muscles from the thyroid cartilage, the left piriform sinus is not released. The hyoid is then detached from the suprahyoid musculature with exposure of the pre-epiglottic fat body and preparation of the mucosa on the lingual epiglottis surface up to the upper edge of the epiglottis, without opening the pharynx first. The tracheostoma is then created. For this purpose, the 3rd tracheal clasp is cut caudally and the caudal mucocutaneous anastomosis is created. The patient is then reintubated without any problems. The 3rd tracheal clasp is then incised in an H-shape and the cartilage clasps are sutured to the side. Then transition to laryngectomy. For this, the larynx is first removed caudally under the cricoid. A caudally pedicled mucosal flap is then prepared, which will seal the tracheal chimney upwards towards Hermann. Removal of a marginal incision from the remaining endolaryngeal mucosal tissue from the specimen, which proves to be tumor-free on frozen section histology. Then dissection on the back of the cricoid cartilage down to the level of the arytenoid cartilage. Here then entry into the hypopharynx. After extending the incision on both sides, the tumor on the left side is visible. This shows that the first incision was made somewhat close to the tumor, so that an additional strip of mucosa is removed. The incision is then made on the right side along the epiglottis, leaving out the piriform sinus. On the tumor-bearing side, the tumor is cut around with an appropriate macroscopic safety distance of 1-11/2 cm and then joined in the area of the upper epiglottis edge or vallecula during the incision so that the larynx can be removed together with the pharyngeal part. Subsequently, circular marginal incisions are made from the pharyngeal defect. Dysplasia that does not correspond to CIS is still found in the area of the left hypopharynx. Nevertheless, resections are performed on this side and a new frozen section histological examination of the margin is performed, which then proves to be free of tumor and dysplasia. The defect measures approximately 9 cm in length and 6 cm in width. <CLINICIAN_NAME> then lifts the corresponding radial lobe in this size. Then remove the radial forearm flap on the left (<CLINICIAN_NAME>/PJ): Palpatory identification of the distal radial artery. Draw the flap boundaries 10 x 6 cm in the distal forearm proximal to the retina colum flexorum with an S-shaped course. Cut 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. Dissection of the vein distally and with integration into the radial flap graft edge. Identification of the external ramus of the radial nerve and elevation of the radial portion while leaving the tissue of the brachioradialis muscle intact. Then incision down to the tendon of the flexor carpi radialis muscle, taking care to leave the peritendineum on the flexor tendons and to spare the ulnar nerve. Now identify the distal radialis and clamp it with a vascular clamp. After 5 minutes under good oxygen saturation measured by pulse oximetry on the thumb, the vessels are removed with subsequent ointment thread ligation after the pedicle has already been detached from the base, namely from the pronator quadratus and flexus policis longus muscles. Bipolar coagulation of the outgoing perforators and treatment with vascular clips into the cubital fossa. Exposure and sparing of the radial nerve in the median side of the brachioradialis muscle. Exposure of the ulnar and brachial arteries. The median cubital vein and the cephalic vein are also included, so that there are now 2 veins for anastomosis and the radial artery with an appropriate diameter is also removed proximally and treated with a lateral ligature. Hemostasis, two-layer wound closure in the area of the proximal forearm and distal graft bed with split skin from the right thigh in the usual manner. The split skin was previously lifted by <CLINICIAN_NAME>. Application of a wound dressing and forearm splint. Subsequent suturing of the caudally pedicled mucosal flap on the tracheal chimney according to Hermann. Subsequently, myotomy of the constricotr pharyngis muscle and implantation of the Provox-Riga voice prosthesis. After removal of the radial lobe graft, it is sutured into the defect with single button sutures. The vascular pedicle is guided to the left side. The vessels or the branches of the external carotid artery up to the facial artery are extremely weak in caliber with a strong radial artery. For this reason, the maxillary artery is shown close to the external carotid artery and, after cutting through the digastric muscle, is followed as far as possible to the cranial side. Once there, it is displaced caudally together with the external carotid artery under the dissected hypoglossal nerve and anastomosed with the radial artery, which has approximately the same diameter. After the arterial anastomosis, the two venous anastomoses are made in an end-to-side manner to the internal jugular vein. A Redond suction drain is then placed on both sides and a drainage flap on the left side. Folding down of the apron flap and multi-layer wound closure with subsequent completion of the mucocutaneous anastomosis and reintubation of the patient onto a 10-gauge tracheostomy tube, which is fixed to the skin with 2 sutures. Sterile wound dressing. End of the operation, transfer of the patient to anesthesia. Conclusion: Total laryngectomy with partial pharyngectomy and defect coverage with a microvascular anastomosed radial lobe graft from the left forearm with simultaneous primary voice rehabilitation by implantation of a Provox-Riga voice prosthesis and myotomy of the constrictor pharyngis muscle due to a cT3 sinus piriformis carcinoma on the left side.