Transfer of the patient to the operating theater. Introductory consultation with the anesthesia colleagues and induction of intubation anesthesia by the colleagues. After anesthesia has been administered, the surgeon positions the patient's head. First, the flexible gastroesophagoscopy is performed in the usual manner. This reveals the presence of an axial hiatal hernia. Despite a positive diaphanoscopy, a PEG tube is not inserted in consultation with <CLINICIAN_NAME>. The nasogastric tube is inserted. The right arm is then repositioned, the surgical field is wiped sterile after injection of Suprarenin cervically on both sides in the area of the skin incision. Sterile wiping and draping of the patient. Start of the operation by performing a protective tracheostomy. To do this, make an incision just below the cricoid cartilage over 1.5 cm. Cut through the cutaneous-subcutaneous tissue. Identification of the infrahyoid musculature. Identification of the thyroid isthmus. Sharp incision of the cricoid cartilage. Undermining the thyroid isthmus with the clamp. Performing isthmus splitting after extensive bipolar coagulation. Exposure of the anterior tracheal wall and incision in the 2nd to 3rd intertracheal space. A visor tracheotomy is inserted and epithelialized in the usual manner using sutures. The patient is then reintubated and enoral tumor resection begins after insertion of the mouth retractor. Snare the tongue and begin tumor resection with the harmonic knife from anterior to posterior. A palpatory distance of approx. 1 cm from the tumor is maintained. During dissection, a branch of the lingual artery is exposed in depth. This can be safely exposed and ligated. After removal of the tumor specimen, it is placed on a cork plate and the anterior, posterior, lateral and medial resectate margins are marked. Basally, the specimen is marked short long anterior basally and long long posterior basally. The specimen is sent for frozen section diagnostics. After receiving the histology, a narrow resection margin of 0.4 cm is seen basally anteriorly. A new piece is then removed from the anterior basal wound bed and also sent for final histopathological assessment, this time marked with a suture. After subtle hemostasis using bipolar coagulation forceps, the radialis graft is lifted from the right arm by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Palpatory identification of the distal radial artery. Marking of the flap borders (4.5 x 7.5 cm) on the distal forearm, proximal to the flexor retinaculum, with an S-shaped incision running proximally into the cubital fossa. Incision of cutaneous and subcutaneous tissue starting proximally. Identification and visualization of the venous confluence in the cubital fossa. Identification of the cephalic vein and dissection of the vein distally with integration into the radial graft margin. Identification of the ramus externus of the radial nerve and elevation of the radial portion, leaving the peritendineum of the tendons of the brachioradialis muscle intact. Subsequent ulnar incision down to the forearm fascia. Incision of the fascia and subsequent subfascial elevation of the ulnar edge of the graft up to the tendon of the flexor carpi radialis muscle. Care is taken to leave the peritendineum on the flexor tendons and to protect the ulnar artery. Successive detachment of the flap pedicle from the M. pronator quadratus and M. flexor pollicis longus with ligation of the outgoing perforators using a vascular clip into the cubital fossa. Exposure and protection of the radial nerve on the medial side of the brachioradialis muscle. Identification of the distal radial artery and trial clamping with a vascular clip. After 5 minutes under good oxygen saturation measured by pulse oximetry (measured on the index finger), the vessels are removed with subsequent ligation. Visualization of the brachial artery, V. mediana cubiti, A. ulnaris. First the radial artery is removed, then two veins of the superficial venous system. Vascular ligation by means of a bypass ligature (artery) and vascular clip (veins). Subtle hemostasis in the area of the wound bed using bipolar coagulation forceps. Two-layer wound closure in the area of the proximal forearm. Defect coverage of the graft bed with split skin from the right thigh in the usual manner. Suturing of preparation swabs. Application of a wound dressing and a forearm splint. Completion of the graft lift without complications. Neck dissection is first performed on the left side. Here, regions I - IV are removed while sparing all non-lyphatic structures, including the gl. submandibularis. The superior thyroid artery and the facial artery are then dissected for subsequent anastomosis. Now also similar neck dissection on the right. Here, region Ia and Ib are also completely removed, but the submandibular artery is only mobilized as far as necessary and then refixed in its old position. After removal of the radialis graft, the graft is pulled through the defect tunnel. Insertion of the graft in the specified location and suturing using several single button sutures in the usual manner. Anastomosis of the radial artery to the superior thyroid artery and of 2 veins in an end-to-side manner to the internal jugular vein. At the end, subtle hemostasis using bipolar coagulation forceps. The neck is now dry. Wound closure using cutaneous and subcutaneous sutures in the usual manner after insertion of a flap.