After appropriate preparation, the PEG is first inserted without complications by <CLINICIAN_NAME> and <CLINICIAN_NAME>. The tracheostomy is then performed by <CLINICIAN_NAME> and <CLINICIAN_NAME>. A small tracheostoma is created and the patient is then easily intubated. Subsequently, transition to tumor resection transorally through <CLINICIAN_NAME> and <CLINICIAN_NAME>. After insertion of the mouth retractors, the tongue is first sutured to the tip of the tongue on the right and luxated outwards. The tumor located on the left edge of the tongue and the adjacent floor of the mouth can now be seen. On palpation, it extends to the midline in the posterior third of the tongue. The resection is then performed with the ultrasonic knife at an appropriate distance from the tumor, which is not easily palpable in the body of the tongue, especially in the dorsal area. The tumor is then gradually developed, whereby the resection also includes the adjacent floor of the mouth up to just before the ascending mandibular branch. Medially, the midline of the tongue is partially crossed in order to obtain a sufficient palpatory safety margin. In the dorsal direction, the resection can be moved laterally again at the beginning of the base of the tongue. The left half of the tongue is then completely resected. During the final inspection of the resection specimen, a suspicious area can be seen macroscopically on the underside, as the base of the tumor. This is test excised. Here, the frozen section diagnosis still reveals parts of the squamous cell carcinoma. Therefore, another extensive resection is performed in the area of the tumor base, so that the lingual artery on the opposite side is also left intact by the resection, but must be visualized. In this resection, there is no more tumor in the frozen section histology, so that an R0 resection can be assumed. The defect measures 11 x 6 cm. The radial lobe of <CLINICIAN_NAME> and <CLINICIAN_NAME> is also elevated at this size. Palpatory identification of the distal radial artery. Marking of the flap borders (6 x 11 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 spare the ulnar artery. Identification of the distal radial artery and trial clamping with a vascular clamp. After 5 minutes with good oxygen saturation measured by pulse oximetry (measured on the index finger), the vessels are removed with subsequent ligation (Prolene 6.0). Successive detachment of the flap pedicle from the M. pronator quadratus and M. flexor pollicis longus with ligation of the outgoing perforators using a vessel clip into the cubital fossa. Exposure and protection of the radial nerve on the medial side of the brachioradialis muscle. Exposure of the brachial artery, V. mediana cubiti, A. ulnaris. First removal of the radial artery, then of 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. In the meantime, selective neck dissection of regions I to V is performed on both sides. On the left side, the facial artery is dissected up to the mandible and the digastric muscle is severed. After appropriate lifting of the radial lobe graft, it is inserted into the defect via the submandibular lobe and sutured in place. The arterial anastomosis is performed at the confluence of the lingual artery and the facial artery, as only here is there sufficient caliber for anastomosis with the radial artery, which has a large caliber. After performing the arterial anastomosis, the venous anastomosis is performed with the 2 arm veins in an end-to-side manner to the internal jugular vein. Finally, multi-layer wound closure after insertion of a Redon suction drain and a drainage flap on the left side. Finally, the patient was reintubated onto an 8-gauge tracheostomy tube without any problems. The flap is vital at the end of the operation. End of the operation and transfer of the patient to anesthesia. Conclusion: Transoral resection of a tongue carcinoma on the left side in the sense of an extensive left-sided hemiglossectomy. Selective neck dissection of regions I to V on both sides, defect coverage with a microvascularly anastomosed radial flap graft from the left forearm with coverage by split skin from the right thigh, insertion of a PEG tube and a temporary tracheostomy.