After appropriate preparation, first PEG placement by <CLINICIAN_NAME> and <CLINICIAN_NAME>. After appropriate diaphanoscopy, the PEG can be placed and fixed in the usual way without any problems. Subsequent transition to tumor resection. After appropriate adjustment, the tongue is dislocated to the left and the tumor is resected with the monopolar caustic at an appropriate safety distance. The final examination reveals a tumor that has been removed from all sides in healthy tissue. Only laterally does the mucosa appear somewhat questionable. Therefore, another resection is performed laterally. Subsequently, circular margin sections are taken from the wound area, which are found to be R0 by frozen section histology. A complete R0 resection can therefore be assumed. The neck is then dissected on the left side. Here, regions I to V are completely removed while preserving all non-lymphatic structures. There is no clinical evidence of a suspicious cervical lymph node metastasis anywhere. Subsequent transition to the right side. Here too, the same procedure with the same findings. In addition, the predictable defect is created enorally during the submandibulectomy. Dissection of the tendons of the digastric muscle and skeletonization of the hypoglossal nerve. A large caliber facial vein is available for venous anastomosis, which is ligated accordingly. The facial artery is also suitable for anastomosis, as both the lingual artery and the superior thyroid artery are very small in caliber. A Redon and suction drain is then placed in the left side of the neck and the skin is closed in several layers. Removal of an 8.5 x 8 cm split-thickness skin graft from the left thigh. Sterile wound dressing. After removal of the radial flap graft by <CLINICIAN_NAME>, it is sutured into the mouth by <CLINICIAN_NAME> and the stalk is passed outwards into the neck. The patient is then handed over to <CLINICIAN_NAME> . Now lift the radialis graft on the left side. Marking of the graft, palpation of the radial artery and ulnar artery. Marking of the course and also marking of the cephalic vein, which unfortunately runs extremely far laterally and cannot be integrated into the graft. Then creation of the tourniquet and cutting around the graft and extension into the forearm as far as the elbow. Then expose the brachioradialis muscle, expose the venous star, expose the confluence, which is extremely small. Exposure of the superficial ramus, the radial nerve with 3 branches, all 3 branches can be preserved. Exposure of the radial artery with accompanying veins. Clamping and transection of the radial artery, then lifting of the radial flap from the tendon bed. Dissection of the pedicle up to the elbow and removal of the radial artery graft, taking 2 veins with it, a superficial vein and a deep vein including confluence. The arm is then covered in the usual way with split skin from the right thigh and a dorsal forearm splint is applied. The graft was sutured in place by <CLINICIAN_NAME>. Then anastomosis of the radial artery with the facial artery and two veins to 2 branches of the facial vein. After connection of the flap, relatively heavy bleeding occurs from the flap vessel, which runs penetrating through the tunnel into the neck. The flap must then be detached again at the tip of the tongue. An open outlet can now be discovered in the area of the radial artery, which is clipped. This stops the bleeding. Refixation of the flap. Insertion of a Redon drainage (Jackson-Pratt) and two-layer wound closure. Completion of the procedure without complications. The patient goes to the intensive care unit intubated and ventilated. Please continue antibiotics for 24 hours postoperatively, longer if necessary. Flap checks, Hb checks according to the usual schedule.