After induction of anesthesia and intubation transnasally by the anesthesia colleagues. Sterile washing and draping. Now entering with the Kleinsasser tube and inspection of the tumor. As described above, the tumor is located at the base of the tongue on the right side with transition to the left side and is very large in size and CT morphologically also infiltrates the inner muscles of the tongue and infiltrates the hyoid bone. Then looping of the tongue and insertion of a covered retractor. Pre-luxation of the tongue in this way and also with the Kleinsasser tube it is not possible to expose the tumor transorally. It is therefore decided to perform the complete tumor resection transcervically. For this purpose, an apron flap is created in the usual manner. Exposure of the sternocleidomastoid muscle, the omohyoid muscle and the submandibular gland. A lymph node was removed externally in level II. Massive scarring down to the accessorius nerve and the internal jugular vein. The accessory nerve has completely disappeared in a scar block, the internal jugular vein, the accessory nerve and the hypoglossal nerve can only be separated from the scar block with great effort. This also results in tearing of the facial vein, which is also located in the scar block area and must be ligated and removed. Now remove the neck block IIa to Va while sparing the plexus branches. There are several suspicious lymph nodes in levels IIa and b and also macroscopically suspicious lymph nodes in the other regions III and IV; all levels are sent individually to the pathology department. Neck dissection left <CLINICIAN_NAME>: Locate the anterior border of the sternocleidomastoid muscle and expose it. Dissection of the omohyoid muscle to the cranial side of the digaster muscle. Exposure of the accessorius nerve. Locate the gl. submandibularis and expose the gland. Fold up the gland and expose the digaster muscle. Locate the VJI and dissect the large anterior jugular vein. Dissect the JVJ from cranial to caudal. The outlet to the facial vein is bypassed. Locate and preserve the hypoglossal nerve. Removal of the medial neck preparation. Now dissect the lateral neck preparation and remove it while sparing the plexus branches. Finally, a supraclavicular lymph node is successively dissected out. No increased bleeding, no chyle. Now measurement of the defect 12 x 6 x 5 cm. In the meantime, marginal samples were taken from the specimen itself and sent to the pathology department. All margin samples on the specimen were R0, therefore no resection necessary. The graft is now marked on the forearm and the skin incision is made. Then visualization of the vein situation in the crook of the elbow. Visualization of the venous confluence. Visualization of the brachialis muscle, visualization of the superficial ramus of the radial nerve. Exposure of the radial artery. Now take over the graft elevation by <CLINICIAN_NAME>. Detachment of the graft from the vein bed. Exposure of the pedicle in the usual manner. Outlets are clipped. Then take over <CLINICIAN_NAME> again and place the graft in the crook of the elbow. Two superficial veins and one deep vein are lifted. The graft is then sutured into the defect. This is somewhat difficult as the defect extends into the oral cavity area in the floor of the mouth and ends at the vallecula. In the end, the graft is sutured in completely. The vessels are then exposed on the right side. Here the superior thyroid artery is used as the connecting vessel and 2 outlets from the internal jugular vein in the distal area. All vessels are anastomosed. The veins are couplerized. There is good graft perfusion. At the end, the tracheotomy is performed and the apron flap is sutured in place. Before this, 2 Redon drains were inserted. The procedure is completed without complications. The patient is ventilated and admitted to the intensive care unit. Please continue antibiotics for at least 24 hours. Regular flap control according to the usual schedule and presentation of the patient at the tumor conference after final histology to plan adjuvant radiochemotherapy. The patient has already verbally agreed to adjuvant radiochemotherapy in advance.