Induction of anesthesia and intubation by the anesthesia colleagues. Then the tracheotomy is first performed by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Tracheotomy: Marking of the landmarks and injection of lidocaine with suprarenin. Sterile ablation and draping. Skin incision and dissection through the subcutaneous fatty tissue. Now strict dissection in the midline through the prelaryngeal muscles to the thyroid gland. This is coagulated below the cricoid cartilage and undermined using a clamp. Careful bipolar coagulation of the thyroid gland and separation of the latter. The anterior wall of the trachea is now exposed over a large area and with a good overview. Insertion between the 2nd and 3rd tracheal clasp. Suturing of the tracheostoma. A 9 mm blocked cannula is inserted without any problems. There was also no bleeding or complications during the tracheostomy. Repositioning and sterile washing and draping. Then insertion of a Mc Ivor oral catheter and start of tumor resection. The tumor is located on the posterior wall of the right oropharynx, crosses the midline and infiltrates the posterior and partially also the anterior palatal arch as well as the tonsil and ends in the vallecula on the right side. Beginning with tumor resection in the cranial part transorally. The tumor is lifted directly from the prevertebral fascia, although this is not infiltrated macroscopically. Involving the posterior and partially the anterior palatal arch. The tumor encompasses the tonsil and can be further dissected laterally. The tumor then reaches far into the cervical vascular sheath, so that fatty tissue and larger blood vessels are already visible transorally. Now the overview becomes very unclear, so the decision is made to dissect further transcervically. To do this, incise the skin in the usual way and first perform the neck dissection. Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular and digastric gland, free dissection of the cervical vascular sheath. There are several nodes in level IIa and partly also IIb, these are lifted off the cervical vascular sheath in the conglomerate. This is possible without any problems. The accessorius nerve, hypoglossus, facial vein, superior facial artery and facial artery can all be preserved. Then enter enorally via the existing defect and dislodge the tumor. Then complete the tumor resection from the transcervical side. The tumor is placed on cork and sent to the pathology department for a frozen section. All margins are free of carcinoma and carcinoma in situ. The tumor specimen shows severe dysplasia only on the medial side of the margin to the left. The pathologist recommends taking another resection. This is done including a marginal sample. The margin sample is sent for final histology. Overall, the tumor can be resected on specimen R0. Then transition to neck dissection on the left side. Here again, the skin incision is made in the usual way. Exposure of the sternocleidomastoid muscle, omohyoid muscle, submandibular gland, digastric muscle, exposure of the cervical vascular sheath. Sparing of the accessory nerve, hypoglossal nerve, cervical sinus, facial vein, superior thyroid and clearing of neck levels IIa to Va while sparing the plexus branches. Insertion of a redon drain and two-layer wound closure. Elevation of the radial lobe graft by <CLINICIAN_NAME>, <CLINICIAN_NAME>: First marking of the 9 x 10 cm graft. Skin incision and dissection through the subcutaneous fatty tissue. Locate the cephalic vein and dissect laterally from this to the musculature. Successive vascular dissection distally. Care is taken here to ensure that sufficient subcutaneous fatty tissue remains on the skin to avoid necrosis. Now carefully dissect the venous star. In the next step, both the flexor carpi radialis and the brachioradialis are dissected up to the ulnar flexion. Now carefully dissect along both muscles in depth. Small muscular vascular branches are glued or coagulated using bipolar coagulation. Locate the pedicle in depth and separate it from the surrounding area. Now further dissection distally. Skin incision of the ulnar flap edge and dissection of the fasciocutaneous flap up to the flexor carpi radialis tendon. The ulnar artery can be easily palpated and spared. Smaller venous outflows are coagulated. Now blunt exploration and dissection with the clamp to find the radial artery. This can be located, shows good pressure and is sutured using a lateral suture. Now further dissect the cephalic vein distally. This can be included in the flap. Lateral accesses are cut off. The superficial ramus of the radial nerve can be spared without any problems. The posterior cutaneous flap is now also dissected from the radial side using the scalpel on the underlying muscles. After further precise exploration of the venous star and exposure of the superficial and deep veins as well as the ulnar, radial and brachial arteries, the flap pedicle is now removed distally and proximally by means of a ligation. Suture the fascia to the subcutaneous tissue to prevent the flap from shearing off. Dissection of the pedicle vessels. Now perform the microanastomoses through <CLINICIAN_NAME>, the radial artery is anastomosed end-to-end with the superficial thyroid artery. The two veins are also supplied microanastomotically using a suture technique. Here the venous vessels are connected end-to-side into the internal jugular vein. After anastomosis, there is a good pulse as well as good filling of the vein after spreading. Suturing of the stalk in the desired position with Vicryl 3-0. Insertion of a Redon drainage and a Penrose drainage. Subcutaneous suture using Vicryl 3-0 and skin suture using Ethilon 4-0. Marking of the Doppler using a Vicryl thread. Final consultation with the anesthetist. The patient is transferred to the intensive care unit without any major complications.