Dictation <CLINICIAN_NAME>: After appropriate preparation, first disinfect the skin. Infiltration with local anesthetic containing adrenaline in the area of the subsequent skin incision. First perform the tracheoscopy. After skin incision, dissection in the median plane through the linea alba onto the isthmus, which is passed underneath. The isthmus is then ligated so that the first 5 tracheal clips can be visualized. Subsequently, visual tracheostomy between the 3rd/4th tracheal clasp with reintubation of the patient. Completion of the mucocutaneous anastomosis with 2 sutures each cranially and caudally. Subsequent reintubation of the patient. Now adjust the tumor with the 2nd mouth retractor. Tightening of the tip of the tongue. The tumor is palpable in the posterior quarter of the tongue on the left side in the area of the glossotonsillar groove. Start with dorsal tumor resection, whereby the resection incision is made in the upper third of the tonsil bed and is initially made laterally up to the lower jaw. The tumor area is then resected by palpation at a distance of 1-2 cm towards the front and middle. Thus, under constant palpatory control and at an appropriate safety distance, the tumor is successively separated from the body of the tongue, initially the lateral floor of the mouth, as well as the base of the tongue using the ultrasonic knife. The hypoglossal nerve and the lingual nerve are severed. Finally, the tumor-bearing tissue block can be removed in toto. Macroscopically, the tumor is surrounded on all sides by musculature. Removal of marginal incisions circularly around the defect as well as from the tumor base. These all proved to be tumor-free, only the back of the tongue and the anterior floor of the mouth showed moderate dysplasia, so that resections were carried out here, but these were free of further dysplasia. These areas were also previously furthest away from the tumor, so there is certainly no connection with the tumor here. The main specimen is also examined using frozen section histology and is also found to be R0 in depth into the musculature. Subsequent sterile washing and draping. Transition to neck dissection on the left. After skin incision, regions II to V are successively removed while preserving all non-lymphatic structures. Then evacuation of regions Ia and b and removal of the submandibular gland, with automatic access to the oropharynx. Dissection of the digastric muscle. Dissection of the facial vein as well as a vein located further caudally for subsequent anastomosis. The superior thyroid artery is also dissected, but its caliber is quite small. Therefore, the facial artery is also dissected up to the mandible for later anastomosis. Dictation <CLINICIAN_NAME>: Acceptance of the operation by <CLINICIAN_NAME>. Marking of the graft on the forearm 10.5 x 6.5 cm, which was measured by <CLINICIAN_NAME>. Start with the flap elevation on the left forearm using <CLINICIAN_NAME> and <CLINICIAN_NAME>. Expose the brachioradialis muscle for this. Exposure of the cephalic vein. Visualization of the venous star in the antecubital fossa. Exposure of the confluence. Incision of the graft. Exposure of the superficial ramus of the radial nerve. Exposure of the radial artery, resulting in tearing of a branch from the superficial ramus of the radial nerve that runs to the thumb. This is sutured with 8.0 Prolene. Lifting of the graft from the tendon bed. Dissection of the pedicle up to the crook of the elbow. Removal of the pedicle with two superficial and two deep veins and flushing of the graft with heparin in the usual manner. Removal of full-thickness skin directly from the forearm and thinning of this full-thickness skin. Then preparation of the wound bed on the forearm by approximating the wound edges in the graft harvesting area. Then suturing of the full-thickness skin in the usual manner and turning to the oropharynx and the oral cavity. Inspection of the site again. Hemostasis. It is now clear that the defect is larger than expected and extends to the vallecula in the caudal region. This defect was partially primarily adapted here by <CLINICIAN_NAME> and the soft palate was also partially closed by <CLINICIAN_NAME>, in which a part of the healthy side including the uvula was sutured to the left. In the caudal area where the partial primary wound closure in the pharynx took place, a second suture was applied to close the area more tightly. Now insert the flap and start suturing. This is relatively difficult as the graft is quite small for the large defect. In the end, the graft was successfully sutured into place. The stalk was removed into the neck. Then anastomosis between the radial artery and facial artery and anastomosis of the veins through two couplers at the outlets of the internal jugular vein. Insertion of a Penrose drain and two-layer wound closure. The patient is ventilated and admitted to the intensive care unit. Please continue flap checks according to the usual schedule and antibiotics for at least 24 hours.  