Induction of anesthesia and intubation by the anesthesia colleagues, then insertion of the spandex and a covered retractor and inspection and palpation of the tumor region. On inspection, the tumor appears relatively superficial, but on palpation the tumor extends to the midline into the tongue muscles and also into the deep tongue muscles. Intraoperative consultation of <CLINICIAN_NAME> and demonstration of the findings. It became clear that defect coverage using a free transpalantate would be necessary after the tumor resection, so it was decided to perform only the tumor resection on this day and to perform defect coverage using a free radialis graft and neck dissection in a two-stage procedure. Unfortunately, preoperative planning in this regard was not possible due to the patient's lack of compliance. The diode laser was initially set to 20 watts and the tumor region was first cut around the upper edge of the tongue. In the course of the operation, the wattage must be increased to 30. The tumor is partially resected using a monopolar needle. Ultimately, the tumor is completely removed with a safety margin of 1 cm. The entire specimen is placed on cork for frozen section, all margins including the deep margins are free of carcinoma. There is still carcinoma in situ at the margin of the floor of the mouth, so a resection is taken here and a margin sample is taken again for frozen section. All margins are definitively R0. Higher grade dysplasia at the dorsal margin in the floor of the mouth, therefore a resection is taken here and a margin sample is taken, which is finally sent for histology without a frozen section. Overall, all margins R0 in the frozen section. Hemostasis with bipolar coagulation and completion of the procedure without complications. Please plan graft coverage without delay using a radialis graft and neck dissection. A day point must be reserved for this. In this case, it is also possible to perform the operation on a Tuesday, Wednesday or Friday if the pre-reserved flap appointments are already taken. The surgeon repositions the patient for the tracheotomy in the head reclination position. Injection of Suprarenin below the cricoid cartilage (8 ml). Sterile abjodation and draping of the patient. Skin incision 1/2 cm below the cricoid cartilage (horizontal). Bipolar coagulation of the superficial veins. Spreading dissection of the infrahyal musculature and vertical incision. The infrahyal musculature is pushed laterally on both sides and the cricoid cartilage is exposed. Exposure of the thyroid isthmus and undermining of the thyroid isthmus with a clamp. Bipolar coagulation of the isthmus and gradual sharp transection. Push the thyroid flaps away from the trachea and bipolar coagulation until the wound is completely dry. Identification of the incision site between the 2nd and 3rd tracheal ring. Sharp incision of the trachea after saturation of the patient. Visor tracheotomy. Suturing of the tracheostoma first at the lower, then at the upper part in the sense of an epithelialized tracheostoma. Removal of the tube and insertion of an 8 mm tracheostomy tube. Completion of the tracheostomy without complications.