Transfer of the patient to the operating theater. Consultation with the anesthetist. Subsequent transoral tumor resection: After appropriate preparation, insertion of the mouth retractors. Rein suture of the tip of the tongue and disluxation of the tongue. The tumor located on the right middle edge of the tongue is then resected with scissors in the sense of a hemiglossectomy and macroscopically far into the healthy tissue. Repeated careful hemostasis and bipolar coagulation and ligation of several larger arterial branches. The specimen is sent for frozen section histology diagnostics and is found to have been resected well within the healthy tissue. After completion of the tumor resection, measurement of the defect with a size of about 8 x 4 1/2 cm. Transition to neck dissection on both sides and elevation of the radial lobe graft from the left forearm. Subsequent repositioning for neck dissection on both sides and defect coverage. Sterile draping of all surgical areas. Injection of a total of 10 ml Ultracaine 1% with adrenaline per side of the neck. Neck dissection on the right: incision in a submandibular neck fold. Exposure of the sternocleidomastoid muscle, omohyoid muscle, digastric muscle and infrahyoid muscles. Visualization of the internal jugular vein, internal carotid artery, external carotid artery, visualization of the superior thyroid artery and facial artery. There is no adequate external jugular vein. However, there is a good facial artery with several outlets. Clearing of the lymph nodes level II to IV, including visualization of the cervical artery, vagus nerve, hypoglossal nerve and accessorius nerve. All nerves are exposed, dissected out and re-embedded. Several slightly enlarged lymph nodes, but none clearly positive. Neck dissection on the left side: This is performed in the same way as on the right side. Levels II to IV are removed in the same way. Some enlarged lymph nodes are also found here. The radial lobe graft is then removed. Removal of the radial lobe (<CLINICIAN_NAME>): Measurement of the defect in the area of the oral cavity. After glossectomy, the defect is 8 x 4 cm. A spindle-shaped graft is drawn in the area of the forearm, palpation of the radial and ulnar arteries. Draw the cephalic vein from the proximal end of the graft in a curved line to the crook of the elbow, then make an incision in the opposite direction in the proximal part of the forearm approx. 7 x 3 cm so that after removal of the radial flap, full-thickness skin is obtained from the forearm and used to close the resulting defect in the radial flap. Now incise the skin using a 15 mm scalpel, cut through the skin and subcutaneous tissue to the proximal end of the flap. Expose the brachioradialis muscle and the flexor carpis radialis muscle. Exposure of the pedicle between the muscle bellies. Exposure of the V. mediana cubita, in the crook of the elbow exposure of the V. confluens, exposure of the V. cephalica. The cephalic vein is dissected so that it is integrated into the flap. After complete dissection of the vascular pedicle with 2 deep veins and the radial artery, the skin around the graft is incised. The flap is now dissected in such a way that the vascular pedicle is integrated medially or radially of the flexor carpi radialis. The radial artery is then exposed using clamps and wrapped around with lateral sutures. This tests whether the oxygenation decreases when the radial artery is squeezed. The findings are correct with a sufficient increase in flow through the ulnar artery, so that there is no drop in saturation when the radial artery is squeezed. The remaining flap is now incised, the superficial ramus of the radial nerve is exposed and preserved. The smallest branches that run to the flap are not preserved, but the main branch of the superficial ramus and radial nerve is preserved. All vessels are now exposed in the antecubital fossa and the flap is removed at the distal end. The radial artery is ligated using lateral sutures, the radial artery is removed proximally and the ulnar and brachial arteries are identified and spared. The interosseous artery is separated from the radial artery and integrated into the flap. The cephalic artery is removed proximal to the confluence so that the accompanying veins of the vascular pedicle, the confluent vein and the cephalic vein can be spared and integrated into the flap. The flap is now removed proximally. In the proximal area of the forearm, a spindle-shaped excision of skin is performed as described above and dissected away from the fatty tissue. A 7 x 3 cm full-thickness skin graft can now be sutured into the radial flap defect without difficulty. Proximally, the forearm is primarily closed, double-layered subcutaneous suture using 4-0 Vicryl and continuous skin suture using 5-0 Ethilon. The full-thickness skin is sutured with 4-0 Ethilon. Four small relief incisions are now made to prevent hematoma. Bepanthen ointment is then applied, compresses are sewn in and the arm is bandaged and a dorsal forearm splint is applied in the typical manner. Then incision of the radialis flap: First create a tunnel from the right side of the neck into the oral cavity area. To do this, cut the digastric muscle. Then removal of the submandibular gland. Careful protection and exposure, re-embedding of the lingual nerve. A 2-3 QF tunnel is created in the floor of the mouth. The radialis flap graft is then sutured into the defect with 3-0 Vicryl single button sutures. Tension-free and complete defect coverage. The stalk was previously passed through the tunnel into the neck area on the right side. Here the radial artery and the lingual artery, which is prepared, are used for anastomosis. After conditioning the vessels, suturing is performed using single button sutures 9-0 Ethilon. After opening the clamp, good arterial flow and good venous return. Subsequently, 2 outlets are exposed from the area of the accompanying vein of the radial artery, which have good venous flow. The branches of the cephalic vein have significantly poorer venous flow and are therefore clipped. The veins from the confluence area are anastomosed with 2 veins from the outlet of the facial vein using 2.5 mm and 2.0 mm couplers. Good venous flow after opening the clamps. Positive smear phenomenon. Inspection of the flap enorally, this shows good blood flow. Subsequent clipping of all still open venous outlets. Most careful hemostasis and irrigation. Then wound closure in layers with insertion of 2 flaps on the right side and a Redon drainage on the left side. Due to the swelling, an enoral decision was made to perform a small tracheostomy. Now tracheotomy: skin incision approx. 5 cm long 1 QF below the cricoid horizontally. Sharp cutting of the skin, subcutaneous tissue and platysma using a 15 mm scalpel. The infrahyoid musculature is now exposed. Entering the midline. Cut through the midline with scissors. Expose the thyroid gland. An Overholt clamp is used to enter between the cricoid and isthmus. The isthmus of the thyroid gland is easily bipolarized and severed. A small tracheotomy is then performed between the 2nd and 3rd tracheal cartilage clasp so that a 7-gauge cannula can be inserted. Mucocutaneous anastomosis is performed with Ethibond sutures in the typical manner. Completion of the procedure without complications. Subsequent completion of the procedure without complications. Flap vital at the end of the operation, wound conditions normal. Patient transferred to the intensive care unit on mechanical ventilation. Please continue antibiotics, which were started intraoperatively with Unacid, for 1 week postoperatively. Nutrition via the preoperatively inserted gastric tube for approx. 1 week to 10 days, then, depending on the clinical situation, diet build-up. Flap control according to the scheme for 5 days. Please run heparin perfusor 500 E/h for 5 days. Presentation of the patient at the interdisciplinary tumor conference after receipt of the final histology.