First insertion of the oral retractor and the frontal sinus retractor and resection of the tumor in the area of the left oropharynx. The tumor extends from the tonsil lobe in a cone shape along the lateral pharyngeal wall caudally, passes over to the caudal base of the tongue and takes up about 1/4 of the tongue base growing superficially until it finally passes over to the dorsal floor of the mouth, glossotonsillar groove, mandibular angulus and the soft palate. Here the tumor extends to the parauvular region, where the resection is completed accordingly. The entire specimen is sent for frozen section assessment after marking the wound edges accordingly. Meanwhile, start the left neck dissection: To do this, make a skin incision along a cervical skin fold in the direction of the mastoid. Dissection of cranial and caudal platysmal flaps and exposure of the internal jugular vein and the auricular nerve. While the nerve can be spared, the vein ultimately lies across the situs so that it must be ligated as cranially as possible. Further dissection along the anterior edge of the sternocleidomastoid muscle and exposure of the vascular nerve sheath. Dissection along the omohyoid muscle to the hyoid bone and along the digastric muscle to complete neck dissection level II to IV. Careful elevation of the neck block. A macroscopic metastasis is found in the area of level IIb. Here the accessory nerve passes through one of the two macroscopically conspicuous lymph nodes so that it must be resected. Otherwise, spare all vascular and nerve structures. Subsequently, careful evacuation of level V up to above the cervical plexus. Finally, lateral pharyngotomy after evacuation of level I, taking the submandibular gland with it. This was already visible enorally in the sense of the wound bed. As the frozen section diagnostics that had been performed in the meantime had described an R1 situation in the basal part, among others, this part was completely removed in the sense of a thorough resection. The facial and lingual arteries were ligated. The hypoglossal nerve, however, can be spared. Wide opening of the pharynx to the enoral defect. Neck dissection now follows on the right side by <CLINICIAN_NAME> and parallel to this the elevation of the forearm graft by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Transition to neck dissection on the right side. Mark the course of the mandible and the ascending mandibular branch as well as the mastoid. Create a curved skin incision extending laterally in the area of the anterior edge of the sternocleidomastoid muscle. Sharp dissection of the subcutaneous fatty tissue and the platysma. Subsequent subplatysmal dissection. Subsequent exposure of the anterior edge of the sternocleidomastoid muscle and exposure of the omohyoid muscle as the caudal border. Subsequent dissection of the omohyoid muscle up to the hyoid. Subsequent dissection and visualization of the posterior surface of the sternocleidomastoid and the course of the accessorius nerve. Then move on to exposing the submandibular gland and the digastric muscle as the cranial border. Also exposure and intraoperative protection of the hypoglossal nerve. Beginning of exposure of the cervical vascular sheath. Exposure of the internal jugular vein and the facial vein in its entire course up to the cranial border. The external jugular vein was cut off intraoperatively for reasons of clarity. The course of the common carotid artery was then exposed. After exposure of all the above-mentioned landmarks, the medial and lateral neck specimens are removed after successive dissection. On the right side, apart from the external jugular vein, all large branches of the external jugular vein and external carotid artery were preserved. Hemostasis using bipolar coagulation and wound irrigation with Ringer's solution. Subsequent placement of a 10-gauge Redondra ring and two-layer wound closure. This results in a functional neck dissection on the right side in regions II, III and IV. The findings are then demonstrated <CLINICIAN_NAME>. Meanwhile, elevation of the forearm graft. For this purpose, draw the graft with a size of approx. 10 x 5 cm, taking into account the exact anatomy, so that the width is drawn variably. A skin monitor is integrated into the drawing for postoperative monitoring of the graft. Careful elevation of the graft, taking the cephalic vein with it. Separation of the radial vascular pedicle after appropriate preparation and elevation from distal to proximal into the crook of the elbow. Here the confluence of the superficial and deep venous system is sought out and identified as well as the outlet of the radial artery from the ulnar artery. Appropriate ligatures and removal of the vascular pedicle. Beforehand, the tourniquet (300 mmHg) is opened and careful hemostasis is performed. The lifted graft is now retracted from cervical to enoral and carefully incorporated using appropriate single-button Vicryl sutures (3.0). This results in complete coverage of the defect and satisfactory reconstruction of the oropharyngeal region. Parallel to the incorporation, full-thickness skin is lifted from the right groin and the lifting defect on the right forearm is treated with full-thickness skin and continuous suturing. Application of a vacuum dressing, which should be left in place for 7 days. Splinting of the arm with special attention to finger fixation. Meanwhile cervical vascular sutures. The superior thyroid artery is connected to the radial artery in the sense of an end-to-end anastomosis. The excellent flow of the superior thyroid artery is checked beforehand. After appropriate demonstration of good venous return, the flap vein is now connected to a branch of the facial vein using a size 2.5 coupler in the sense of an end-to-end anastomosis. To stabilize the curved course of the venous vessel and to prevent kinking, a small gelatin sponge is inserted into the curvature. The vascular monitor is now positioned correctly to stabilize the flap pedicle and incorporated into the neck skin. Subcutaneous sutures and skin suture. On the right side, insertion of a 10 mm Redon drain and also subcutaneous and skin sutures. Subsequent tracheostoma placement by <CLINICIAN_NAME> to temporarily secure the airway postoperatively. The stoma can be closed again once sufficient swallowing has been ensured and the swelling has subsided enorally with adequate breathing. The wound in the groin area is primarily treated with subcutaneous sutures and skin sutures. Insertion of an 8-gauge Duracuff cannula with core. This is sutured in place. The sutures should be removed after 5 days. Only then can the cannula be fixed in place with the appropriate tape. Classic monitoring of the transplant for 5 days, according to the applicable regulations and no bandages or tapes in the neck area for at least 5 days. The upper body should be elevated at approx. 45°.