First, induction of anesthesia by the anesthesia colleagues and transnasal intubation. Entry with the flexible oesophagogastroscope and endoscopy into the stomach. No abnormalities here. With good diaphanoscopy, insertion of a PEG tube using the thread pull-through method. This is successful without any problems. Insertion of a covered retractor, looping of the tongue and inspection of the carcinoma. The tongue tumor occupies 2/3 of the tongue on the right side, infiltrates the entire tip of the tongue and crosses the midline. First start with tumor resection using the monopolar needle and alternate dissection with scissors and bipolar forceps. The tumor is cut around successively. In the central area, the resection appears very close macroscopically. A thick slice is immediately resected and sent for final histology. Marginal samples are then taken and sent for frozen section. All marginal samples are tumor-free. Therefore intraoperative R0 situation. Due to the large remaining defect, which has also extended to the floor of the mouth, it is essential to cover the defect. This is done with a radialis graft. Then transition to neck dissection on the right side. Skin incision on the anterior edge of the sternocleidomastoid muscle. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the cervical vascular sheath. Free preparation of the internal jugular vein. Release of the neck block II a to V a, sparing the plexus branches. The external and facial veins can be preserved. Level II contains several conspicuous, coarse nodes. Level II a to V a are removed while sparing the plexus branches and the accessorius nerve. Then neck dissection of the left side and tracheotomy (here follows dictation by <CLINICIAN_NAME>). Lifting of the radialis graft. First measure the size of the graft. This is measured at 16 x 8 cm. Then mark the graft in the area of the forearm. The forearm is small and very adipose. Cut around the skin. Then expose the cephalic vein and basilica in the area of the crook of the elbow. Exposure of the venous star with search for the confluence between the superficial and deep venous system. Exposure of the brachioradialis muscle from proximal to distal. Exposure of the superficial ramus of the radial nerve, which has two branches, both of which are preserved. Exposure of the radial artery. Clamping of the radial artery under pulsoxymetric control. Ligation of the radial artery. Lifting of the radial artery graft from the tendons and development of the pedicle in the usual manner. Deposition of the stem while preserving the interosseous outlet. A superficial vein and a deep vein can also be lifted while preserving the confluence. Separation of the nerve and suturing of the graft into the defect area. This must largely be done transcervically, as the graft cannot be fitted transorally due to the adipose conditions. For this purpose, sutures are placed in the area of the vallecula and the graft is pulled in secondarily. In the area of the soft palate and the tip of the tongue, suturing is continued transorally. In some cases, the graft must be fixed around the teeth. Ultimately, the graft fits well. Then the anastomosis is applied. Suturing of the arterial anastomosis. This succeeds without any problems. Then anastomosis of the two veins. The facial vein and a branch from the facial vein are used here. This creates good pedicle pulsation, which results in good graft perfusion. Insertion of 2 Redon drains and two-layer wound closure on both sides of the neck. The patient is ventilated and admitted to the intensive care unit. Postoperative flap control according to the usual schedule.