Introductory consultation with the anesthesia department. After appropriate preparation, the tumor is initially positioned after insertion of the TE blocker. The tumor and thus the subtotal soft palate is then resected and histologically examined using frozen section histology. On the left side, there are still isolated dysplasias without evidence of an invasive carcinoma. Therefore, a resection is performed at this site as well as a further lateral marginal incision, which then proves to be tumor-free on frozen section histology. Transition to tracheotomy: skin incision in the usual manner below the cricoid cartilage. Exposure of the musculature. Splitting of the musculature in the linea alba. Exposure of the thyroid isthmus. Separation of the thyroid isthmus. Exposure of the anterior wall of the trachea. Entering the anterior wall of the trachea. Entering the trachea between the 2nd and 3rd tracheal cartilage. Creation of a mucocutaneous anastomosis after opening the trachea. Re-intubation to a tracheal cannula was performed at the end of the operation. Neck dissection on the right: skin incision in the usual manner on the anterior edge of the sternocleidomastoid muscle. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland and the digastric muscle. Right at the beginning, several coarse lymph node metastases are seen and palpated in level II and also in level V. Visualization of the cervical vascular sheath. Exposure of the accessorius nerve, the hypoglossal nerve and the cervical sinus. Displacement and, at the end of the operation, re-embedding of the accessory nerve and hypoglossal nerve in the sense of a neurolysis. Dissection of levels II a to V b. The entire neck is full of coarse nodes that extend far into level V b and also partially infiltrate the plexus branches. The smaller branches must also be resected. Larger branches and the accessorius nerve can be preserved. As described above, there are also several metastatic nodes deep supraclavicularly, all of which are removed. At the end, irrigation with hydrogen and Ringer. Removal of the submandibular gland, which is relatively large, and transection of the digastric muscle and formation of an enoral tunnel, which ends directly in the area of the resection, so that no additional pharyngeal defect is generated. The tunnel is 2.5 QF wide so that the flap pedicle can be inserted later without any problems. Turning to the left side: Here also skin incision at the anterior edge of the sternocleidomastoid muscle. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland. Showing the digastric muscle. Exposure of the cervical vascular sheath and clearing of levels II a to V a while sparing the plexus branches and all nerves. Here, isolated enlarged lymph nodes, which are macroscopically not metastasizing. Insertion of a Redon drain. Two-layer wound closure. Application of a pressure dressing. Then start lifting the radial lobe graft from the left forearm. The defect measures approximately 5 x 5.5 cm. First mark the radial lobe graft and the S-shaped skin incision on the forearm. In the opposite direction, make an incision for the subsequent full-thickness skin harvest. After skin incision, expose and dissect up to the periphery of the superficial veins, one of which can later be included in the flap. Push the two muscle bellies apart and completely undermine the vascular pedicle. Dissect distally up to the proximal flap edge. First incise the flap ulnarly and down to the underlying fascia, which is included in the flap. Dissection up to the tendon of the flexor digitorum muscle. Then cut around the flap, also radially, exposing and preserving the sensitive nerve branch to the end. Here too, dissection down to the tendon of the brachioradialis muscle. The pedicle is then completely lifted off proximally distally with the index finger while protecting it and the flap is dissected distally to such an extent that it only remains attached to the artery. Then dissect the confluence in the area of the crook of the elbow. This shows that a total of three veins can be dissected, including the superficial skin veins. After appropriate preparation of the tumor bed and completion of the neck dissection, the flap is then removed and the defect covered with full-thickness skin from the same side of the forearm. The flap is then sutured and the stalk is transferred to the right side of the neck. The arterial anastomosis with the superior thyroid artery is performed here. In addition, two well-promoting veins are connected to the internal jugular vein in an end-to-side manner. After the vascular perfusion is released, intact anastomoses as well as a vital flap can be seen. The third remaining vein is then clipped after it also continues to pump. An Easy-Flow drain is then inserted in the usual manner and the wound on the right side of the neck is closed. Re-intubation of the patient onto an 8-gauge tracheostomy tube. Sterile neck bandage. End of the operation. Handover of the patient to anesthesia. Final consultation with the anesthesiologist. Conclusion: Subtotal resection of the soft palate for uvular carcinoma and reconstruction using a microvascular anastomosed radial flap graft from the left forearm.