First, a diagnostic laryngoscopy is performed to re-inspect the tumor findings. This reveals extensive tumor growth, starting at the posterior pharyngeal wall, at the level of the epiglottis, occupying the entire postcricoid, but leaving the arytenoid humps exposed for more than 1 cm each. The tumor extends through both piriform recesses to the esophageal entrance. Due to the fact that the larynx is not completely covered and the medial piriform recess is not reached by the tumor on either side, the decision is made to preserve the larynx and to perform a complete pharyngectomy in the sense of tumor resection via lateral pharyngotomy from the right. A Gluck-Soerensen incision is now made and the right cervical vascular nerve sheath is dissected. Due to the previous operations and the radiotherapy, a correspondingly scarred picture is seen. Nevertheless, the internal jugular vein and the common carotid artery, bulb, external and internal arteries can be fully visualized. The external artery still shows the superior thyroid artery and the maxillary lingual and facial arteries as outlets. The hypoglossal nerve is also exposed and spared. The hyoid bone is now further dissected and half the hyoid bone is removed for further resection and treatment. Half of the thyroid cartilage is also skeletonized on the right side and the hypopharynx is released. Strict care is taken to ensure that no lesions occur, particularly in the area of the anterior thyroid cartilage. However, as already mentioned, the right thyroid cartilage is removed for further resection of the tumor while preserving the bow. This is followed by a pharyngotomy from the right above the hyoid bone and exposure of the underlying tumor. Complete bypass of the tumor in the area of the posterior pharyngeal wall and complete pharyngectomy in the sense of a circular pharyngeal resection, leaving postcricoid mucosa of approx. 1 cm below the arytenoid cartilage. The remaining tissue is now completely removed and traced down to the esophageal entrance. Approx. 2 cm of the esophageal entrance is also resected due to the tumor growth ending 1 cm above it. The esophagus is fixed with sutures to enable later reanastomization and reconstruction with the flap graft. Quick incisions are taken, which are finally reported as tumor-free. Furthermore, the radialis graft to be lifted is now measured for reconstruction. The result is a modified trapezoidal graft measuring 11 by 8 cm and 6 cm in length. This is then incorporated circularly in the form of a funnel. A small, so-called flap key is formed in the area of the esophagus to prevent subsequent re-stenosis in this area. The graft on the left forearm is now lifted in a bloodless state in the typical manner. Once the graft has been removed and the bleeding has been stopped, it is gradually incorporated, first in the area of the esophageal entrance and then in the hypo-/oropharyngeal area. This ensures good and complete wound closure. In order to mobilize the larynx slightly cranially towards the base of the tongue, the cricoid cartilage is now grasped submucosally with a 0 suture and sutured to the base of the tongue, taking the remaining hyoid bone with it. This results in a clearly visible cranial displacement of the larynx, which should enable the patient to swallow more easily. After closure, the anastomosis is performed accordingly. This involves an end-to-end anastomosis of the lingual artery with the radial artery using single button sutures and an end-to-side anastomosis using a 3.5 mm vascular couplas. Finally, good vascular flow is established and the skin and subcutaneous sutures are applied. As part of the skin suture, the skin monitor of the flap is also integrated into the neck wound. Finally, the Doppler signals are checked, which are documented and are good. Parallel to the incorporation of the flap, <CLINICIAN_NAME> lifts the full-thickness skin in the area of the right groin and incorporates it in the area of the left forearm to cover the lifting defect. A vacuum seal is now applied and activated. Application of a Cramer splint to immobilize the forearm and hand. Finally, reintubation to a Rüsch cannula and suturing of the cannula