Initial consultation with the anesthesiologist. First pharyngoscopy and laryngoscopy: The tumor is seen in the area of the right tonsil lobe with a deep ulcer towards the side wall, at the transition to the hypopharynx and infiltration of the base of the tongue. Therefore, indication for resection with flap coverage confirmed. Placement of the PEG: insertion of the flexible esophagoscope into the stomach. No special features seen during a rough examination. After creation of the diaphanoscopy, insertion of a 15 mm abdominal wall tube without complications in the typical manner. Fixation to the abdominal wall. Skin disinfection again. The patient is positioned. Disinfection of all necessary surgical areas and injection of a total of 15 ml Ultracaine 1% with adrenaline into the sides of the neck on both sides. Start with the transoral tumor resection: insertion of the McIvor spatula or the coated retractor. Exposure of the tumor. This can be cut around cranially, at a distance of 1-1.5 cm on all sides and initially dissected away from the side wall. However, inflammatory infiltration can be seen caudally. Therefore, the procedure is initially aborted transorally. The tumour is still mobilized via the glossoalveolar groove into the base of the tongue. Lateral infiltration of the base of the tongue is clearly visible, so that a resection of the base of the tongue in the caudal region up to just under halfway must be performed. Subsequent neck dissection on the right: skin incision in typical manner. Exposure of the sternocleidomastoid muscle. Exposure of the digastric muscle and exposure of the omohyoid muscle. Exposure of a cystic lymph node metastasis located on the submandibular gland. This is dissected here. Exposure of the internal and external carotid artery as well as the internal jugular vein and facial vein. An external jugular vein cannot be visualized in adequate size. First of all, evacuation level II to V and removal of all relevant or visible lymph nodes. The hypoglossal nerve, vagus nerve and accessorius nerve are also visualized, all of which are preserved. Also the branches of the cervical plexus. Displacement and, at the end of the operation, re-embedding of the hypoglossal nerve, vagus nerve and accessorius nerve in the sense of a neurolysis. The cervical nerve is also preserved. A total of one cystic and several other suspicious lymph nodes. Subsequent continuation of the tumor resection from the transcervical side: for this purpose, the facial vein with all its branches is removed cranially, whereby the branches are prepared for venous anastomosis. Exposure of the external carotid artery, which is ligated. Ligation of the lingual artery and also the facial artery, which are each ligated twice. Subsequent removal of the submandibular gland. Separation of the lingual nerve in the area of the submandibular ganglion and ligation of the duct. The digastric muscle is cut in the area of the tendon and cut laterally. Also the stylohyoid muscle. Then dissection via the hypoglossal nerve and hyoid bone in the direction of the tumor. Dissect the pharyngeal wall. The pharyngeal wall is now dissected from transorally at the upper tonsil pole to the neck side. The entire pharyngeal wall is also resected. The tumor is pulled outwards. The base of the tongue is removed with a sufficient safety margin. Almost half of the base of the tongue is removed caudally. Basally, all soft tissues up to the hyoid bone are removed, the hypoglossal nerve is spared. The tumor is extirpated in toto and suture-marked. Remaining soft tissue in the direction of the hyoid bone or hypopharyngeal entrance and pharyngeal wall is collected again and sent in as a basal margin sample. Overall, both tumor specimen and basal margin specimen in all directions in healthy tissue. Thus R0 status. Measurement of the defect. According to the three-dimensional requirement, this is 7.5 x 7.5 cm, whereby a boomerang-like shape is created with a maximum width of 6 cm. The radial flap is then removed: mark the required flap size on the forearm. Dissection of the flap subfascially from the ulnar side. Then incision up to the crook of the elbow. Exposure of the superficial veins and their connection to the deep venous system. Subsequent radial elevation of the flap. Exposure and preservation of the lateral radial cutaneous nerve. Exposure of the radial artery distally, first clamp off. After sufficient saturation for 10 minutes, the radial artery is then removed. Treatment using puncture ligatures distally and proximally. Then lift the flap by its pedicle up to the crook of the elbow. Outgoing vessels are bipolarly coagulated or clipped. Expose the radial artery. Deposition of the radial artery shortly before entering the brachial artery. The artery is then removed. Treatment using puncture ligatures in the area of the brachial artery. Separation of the veins and ligation proximally. Flushing of the flap with heparin solution. Then removal of a piece of split skin with the dermatome, thickness approx. 0.6 mm. Closure of the wound proximally, primarily in the forearm area. Distally in the defect area, suture the removed split skin. Incision of ball swabs and Mepilex, Octeneden gel in between. Subsequent application of ball swabs and absorbent cotton dressing. Application of a Cramer splint in the functional position and fixation of the forearm using an elastic bandage. Attachment of the arm. Saturation always within normal range. Split skin defect in the thigh area is treated with a hydrogel dressing. Subsequent suturing of the radial flap in the oropharyngeal defect, partly with the sutures in place using 3.0 Vicryl single-button sutures. Sufficient tension-free complete defect coverage. The stalk is guided out. The radial artery is conditioned, as is the superior thyroid artery. Suture the artery with 8.0 Ethilon single-button sutures. Good arterial flow while the clamps are still open. Good venous return. Two outgoing veins of the superficial venous system are conditioned for the venous sutures. Both ends are anastomosed with the outgoing ends of the facial vein. Each with coupler 2.5 mm. Good venous return after opening the clamps, positive smear phenomenon. The facial vein is ligated just above the anastomosed veins. Control of the flap. Good perfusion. Subsequent careful irrigation of the wound area on the right and left. Wound closure in layers on the right and insertion of two flaps and insertion of a Redon drain on the left. Transition to tracheotomy: After skin incision at the level of the cricoid cartilage, the infrahyal musculature is exposed and the anterior wall of the trachea is carefully dissected. The trachea is opened after careful oxygenation. Finally, circular tension-free adaptation of the wound edges in the sense of a mucocutaneous anastomosis. Insertion of an 8-gauge tracheal cannula with suture fixation. Completion of the procedure without complications. Final consultation with the anesthetist. Patient goes to the intensive care unit for postoperative monitoring. Antibiotics administered intraoperatively or preoperatively should be continued postoperatively for one week. Regular checks of flap perfusion clinically and by Doppler according to the skin markings for 5 days. Please continue to administer heparin perfusor 500 units/hour for 5 days. Feeding via the inserted PEG tube for approx. 10 days, then gruel and, if necessary, diet build-up. Total cT2-3 cN2c oropharyngeal carcinoma on the right, R0 status and defect coverage using microvascular pedicled radial flap.