Initial transoral tumor resection: insertion of reinforced retractors and placement of the tumor. The carcinoma, which is located in the middle to posterior third of the tongue, infiltrates into the base of the tongue, submucosally and anteriorly submucosally towards the tip of the tongue. The tumor is removed from all sides with a safety margin of 1.5 - 2 cm. A minimal remnant remains in the area of the tip of the tongue, otherwise the entire tongue, parts of the floor of the mouth with extrinsic musculature and parts of the sublingual glands are removed. Also resection of the lingual nerve. The largest part of the base of the tongue also falls backwards. Tumor is thread-marked for frozen section histology. All edges of the specimen are tumor-free in the frozen section. Thus R0 resection. Now transfer to neck dissection: injection of a total of 10 ml Ultracaine 1% with adrenaline into each side of the neck. First neck dissection on the left: Curved skin incision. Exposure of the sternocleidomastoid muscle. Exposure of the cervical vascular sheath. V. jugularis interna, A. carotis communis, A. carotis interna, externa. Visualization of vagus nerve, accessorius nerve, hypoglossal nerve. Visualization of a rich venous plexus with connection between the external jugular vein, which is double and also has connections to the internal jugular vein via the facial vein. Subsequent evacuation of level II to V. The submandibular gland is also resected cranially. A tunnel measuring 3 QF is then created from transoral to transcervical. This is followed by neck dissection on the right side. This is carried out in the same way as on the left side, exposing the structures mentioned. The submandibular gland is left in place. Levels II to IV are removed. Then elevation of the radial lobe: Marking of the defect in the appropriate extent and size. Maximum length 10 cm, maximum width 6.5 to 7 cm. Mark the flap and cut around it, first from the ulnar and then from the radial side. The radial artery is clamped with the clamp without cutting it first. Then cut up to the olecranon and expose the brachioradialis muscle. Exposure of the vascular pedicle. Exposure of the superficial venous system. Overall stable saturation, no drop, constant 100% saturation in the area of the right hand. Subsequent detachment of the flap from the ulnar and radial subfacial side, taking the superficial venous system with it from the radial side. Preservation of the lateral antebrachial nerve. Separation of the radial artery and treatment of this using a puncture ligature and 4-0 prolene distally and proximally. Subsequent elevation of the flap along its deep and superficial pedicle. Outgoing vessels are treated using a clip or bipolar. Connections between the deep and superficial venous system can be visualized and lifted in the crook of the elbow. 2 ends of the cephalic vein can be removed. Likewise the radial artery before the exit of the interosseous artery. The radial vein is removed after confluence in a new division. A vein remains in the area of the brachial or ulnar artery. Flushing of the vessels with heparin solution. Subsequent insertion of the radial artery flap: insertion into the defect. Successive suturing of the flap with 3-0 Vicryl single button sutures. This is achieved without tension while closing the tongue and floor of mouth defect or base of tongue defect and palatal arch defect. The stalk was passed through the already created tunnel into the left side of the neck. After conditioning the vessels, an arterial anastomosis between the facial and radial arteries was performed using Ethilon 8-0 single-button sutures. After opening the clamp, good arterial flow and good venous return. Subsequent venous anastomosis between an outlet from the bundle between the external jugular vein and the facial vein with connection to the internal jugular vein. Coupler size 3 was used for this, followed by a further anastomosis between the other outlet of the cephalic vein and the remaining external jugular vein using coupler 2.5. Good venous return in each case, positive smear phenomenon. This is followed by careful hemostasis of the entire wound area, irrigation with H202 and Ringer's solution. Subsequently, wound closure in layers on both sides of the neck with insertion of a Redon drain in each case. To cover the wound in the area of the right forearm, a piece of skin measuring approx. 11 x 6 cm was removed from the right groin. After ........... of the skin, the wound is closed in layers with the insertion of a Redon drain. The full-thickness skin is then sutured into the defect. This was successful without tension. The wound towards the crook of the elbow is closed in the typical way in layers. The arm is treated with a hydrogel Mepilex dressing. Loose compress dressing on top. Wrap with a absorbent cotton dressing. Then fit a Cramer splint and wrap the forearm with an elastic bandage. Finally, tracheostoma placement: small Kocher collar incision between the neck incisions. Exposure of the infrahyoid musculature, which is split. Exposure of the thyroid isthmus. This is passed underneath, clamped, severed and supplied by means of a puncture ligature. Exposure of the trachea, which is positioned relatively. Extensive skin mobilization to enable better epithelialization. Finally, epithelialization is achieved with relatively little tension in a typical manner. After insertion of the relatively wide Björk flap, insertion of an 8 mm tracheal cannula is possible without any problems. Completion of the procedure without complications. Patient goes to the intensive care unit for postoperative monitoring. Please continue the antibiotic treatment that was started intraoperatively for one week. Patient should be fed via PEG, if necessary after swallowing porridge in approx. 7-10 days. Heparin perfusor 500 E/hour, which was started intraoperatively, should be continued for 5 days. Flap control clinically and by means of Doppler at the sites marked by sutures for 5 days according to the scheme. Overall cT2-3 tongue margin carcinoma on the left, suspicious lymph nodes on both sides. Procedure after final histology and discussion in the interdisciplinary tumor conference.