After appropriate preparation, the tracheostoma is first created after opening the trachea between the 2nd and 3rd tracheal body. Creation of the mucocutaneous anastomosis and reintubation of the patient. PEG placement by <CLINICIAN_NAME>/<CLINICIAN_NAME>: Advancement of the gastroesophagoscope under constant air insufflation, spontaneous diaphanoscopy. Insertion of a PEG using the thread pull-through method in the typical manner, no complications. Then simultaneous start of elevation of the radial artery graft by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Marking of the radial artery, palpatory identification of the distal radial artery and the ulnar artery. Marking of the flap borders (9 x 5.5 cm) on the distal forearm proximal to the flexor retinaculum with an S-shaped incision extending proximally into the cubital fossa. Incision of cutaneous and subcutaneous tissue from the proximal side. 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 graft margin. Identification of the external ramus, the superficial ramus, the radial nerve, protection of these. Exposure of the vascular pedicle between the flexor carpi radialis muscle and brachioradialis muscle, here dissection of the pedicle without damaging the vessel to be anastomosed. The incision is now made along the flap borders on the distal forearm. Elevation of the radial portion while leaving the fascia of the brachioradialis tendon intact. Subsequent dissection down to the forearm fascia. Incision of the fascia and subsequent subfascial elevation of the forearm fascia of the graft edge up to the tendon of the flexor carpi radialis muscle. Care is taken to leave the peritendinous tissue on the flexor tendon and to protect the ulnar artery. Identification of the artery. Clamp the radial artery with a vascular clamp. After 5 minutes under good pulsoxymetric oxygen saturation measured on the thumb (approx. 98%), the vessels are removed with subsequent ligation with silk thread after the flap umbrella has already been completely detached from the support. Perforators were treated with a vessel clip. Bipolar coagulation. The radial nerve in the median side of the brachioradialis muscle remains intact. The brachial artery was exposed as well as the recurrent radial artery, ulnar artery, radial artery and interosseous artery; the radial artery was removed while preserving all of the above vessels and ligated using a silk thread. Subtle hemostasis in the area of the wound bed using bipolar coagulation forceps. Two-layer wound closure in the area of the proximal forearm and defect coverage of the graft with split skin from the right thigh in a typical manner with stitching of the split skin. Application of a wound dressing, forearm splint, completion of graft elevation without complications. This is followed by transoral tumor resection. The resection includes the anterior palatal arch and the lower 2/3 of the tonsil bed. It extends laterally up to the mandible and passes ventrally into the lateral base of the tongue and the base of the tongue to then extend over the adjacent hypopharynx and then also over the posterior wall of the hypopharynx. The submandibular gland is reached and visualized in depth. The specimen is marked and oriented accordingly on a cork plate before being sent in. In the frozen section histological examination, parts of CIS can still be found in the area of the posterior hypopharyngeal wall as well as in the area of the lateral resection margin in the area of the mandible/ transition to the palatal arch. Corresponding resections are performed here, which are then found to be tumor-free by frozen section histology. Overall, a defect of about 10 x 5 cm is created. The radial artery flap to be removed from the left forearm is the same size. Transition first to neck dissection on the left side. Here, regions I to V are removed while preserving all non-lymphatic structures. The tendon of the digastric muscle is then severed. Dissection of the superior thyroid artery first, which, however, proves to be of small caliber. The lingual and facial arteries are then dissected. Finally, the facial artery is removed from the mandible and beaten downwards and later used for anastomosis. Then create a passage into the oral cavity above the digastric muscle. Perform selective neck dissection of regions II to IV on the right side while preserving all lymphatic structures. There is no clinical evidence of lymph node metastasis on either side. After lifting the radial lobe graft, it is swung into the defect and sutured into the defect both transorally and transcervically. The facial artery is then anastomosed to the radial artery. Venous drainage is achieved through 2 veins at the end of the lateral anastomosis to the internal jugular vein. After completion of Redon wound drainage on both sides, the wound is closed in several layers. Finally, the patient is intubated with an 8-gauge tracheostomy tube. End of the operation, transfer of the patient to anesthesia. Conclusion: Transoral tumor resection of a tumor in the area of the glossotonsillar groove with defect coverage using a free radial flap graft from the left forearm, neck dissection on both sides, tracheostoma placement.