After induction of anesthesia by the anesthesia colleagues, insertion of the mouth guard and inspection of the oral cavity and oropharynx. A submucosally altered tumorous formation was found in the left tonsil region, extending superficially to the edge and base of the tongue. The caudal end of the tumor is difficult to adjust; in any case, it extends beyond the tonsillar lobe to the level of the upper edge of the epiglottis and the entrance to the piriform sinus. Adjustment of the larynx and the hypopharynx and piriform sinus on the right side and also the larynx on the left side as well as the posterior pharyngeal wall, posterior hypopharyngeal wall are free. Start with transoral tumor resection. It is marked with the monopolar needle on the anterior palatal arch and incised. Then further dissection with scissors so that a wide safety margin is created. The tonsil is completely removed together with the surrounding tissue, mucosa and muscles down to the base of the tongue. The tumor resection must then be interrupted as it is no longer clear and the patient is moved to the neck dissection on the left side. Start of neck dissection on the left side. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the cervical vascular sheath. Free preparation of the internal jugular vein. Locating the accessorius nerve. Exposure of the accessorius nerve. Clearing of levels II a, III, IV and V. Exposure of the hypoglossal nerve and digastric muscle. Dissection of the digastric muscle. Removal of the submandibular gland and pushing aside the stylohyoid muscle. Push aside and partially sever the muscles of the floor of the mouth. Then blunt entry into the oropharynx. This is successful without any problems. The tumor can be palpated and inspected. Enlargement of the pharyngostomy and further removal of the tumor via the transcervical approach. This is relatively difficult as the hypoglossal nerve runs to the tongue in this area, but must of course be preserved. With the help of <CLINICIAN_NAME>, the last remnant of the tumor is removed while preserving the hypoglossal nerve. The tumor specimen is thread-marked and sent for histological examination. It can be resected in a frozen section R0. Then complete the neck dissection on the left side and turn to the opposite side. Analogous procedure here. Expose the sternocleidomastoid, omohyoid, digastric and submandibular gland. Clearing of levels II to V a while sparing the plexus branches and exposing the cervical vascular sheath and free preparation of the internal jugular vein. The radialis graft is lifted at the same time. According to the previously performed measurements, an 11 x 8 cm graft is drawn on the left forearm, then the skin is incised. The brachioradialis muscle is exposed. The superficial ramus of the radial nerve is located and visualized, including its branches. Locate and visualize a large vein of the superficial venous system median to the forearm. Locate and expose the radial artery. Clamping and ligation of the radial artery. The pulse oximetry measurement indicates good blood flow to the hand via the ulnar artery. Dissection down to the tendon layer so that the paratendineum is just preserved. Lift the graft from the tendon layer. Then switch to the ulnar side and also develop the flap while preserving the paratendineum of the forearm tendons. Dissection of a long pedicle, preserving a superficial vein and at least one vein ................................................. of the radial artery. The branches are bipolarized and clipped. Dissection of the pedicle up to the crook of the elbow. Dissection of the venous plexus and removal of the specimen with removal of the radial artery and two large-lumen veins. The graft is then fitted into the defect. This is difficult due to the hypoglossal nerve. Incision of the graft by <CLINICIAN_NAME>, who carefully sutures the graft first from the transcervical and then from the transoral or alternating sides. At the same time, the split skin on the right thigh is lifted. Unfortunately, this is also very difficult as there is a technical defect in the dermatome and the knife is also not sharp. Unfortunately, this results in a very large wound area, which is, however, adequately treated afterwards. The arm is closed parallel to the incision in the usual way. First, the upper part of the forearm is sutured in two layers. Then retaining sutures in the defect area. Application of the split skin, which had to be mixed in this case, and suturing of the split skin as well as a Mepilex wound dressing and application of a dorsal forearm splint. Then the anastomosis was applied. First, the arterial vessels are prepared in both the donor and recipient areas and then successively anastomosed using a vascular suture. Turning to the veins. These are also dissected in both the recipient and donor areas and then anastomosed using two couplers. The superior thyroid artery is used for the arterial limb. Then two-layer wound closure and creation of a tracheotomy. For this, skin incision in the usual manner. Dissection down to the infrahyoid musculature. Push aside the infrahyoid musculature and split in the midline. Exposure of the thyroid isthmus. Bipolar coagulation at the thyroid isthmus. Insertion between the 1st and 2nd tracheal cartilage. Creation of a visor tracheotomy. Re-intubation after creation of a mucocutaneous anastomosis and completion of the procedure without complications. The patient is ventilated in the intensive care unit and should receive 500 units of heparin per hour for 5 days. Please monitor the flap and no oral food for one week. After this, an X-ray pre-swallow is performed and if there is no fistula, oral nutrition is possible. After receiving the histology, presentation of the patient in the tumor conference.