After insertion of a mouth guard, endoscopy of the pharynx and larynx to re-evaluate the current findings. Extensive tumor growth is seen, covering the entire soft palate and extending to the alveolar ridge on the right. However, the bone is not infiltrated here. Furthermore, the tumor extends caudally to the lower tonsil pole on the lateral pharyngeal wall on the right and ventrally into the dorsal floor of the mouth. The tumor also extends straight into the base of the tongue. In the following, the tumor is gradually bypassed and resected with the monopolar and bipolar scissors with a safety margin of 1 1/2 cm. The entire soft palate, 1/3 of the right base of the tongue, the posterior and lateral pharyngeal wall on the right and the dorsal floor of the mouth on the right must be removed. The resection ends in the right cheek in depth down to the alveolar ridge, from which the tumor can be easily detached. There is no infiltration here. There is pronounced scar tissue in the depth after surgery and radiation. Maximum resection is performed here except for the internal carotid artery on the right side. The lingual artery is ligated. The findings are sent for histological assessment. This is followed by vascularization on the right: skin incision in the area of the old scar and visualization of the sternocleidomastoid anterior edge. Dissection is also considerably more difficult here due to the previous treatment. The tissue is heavily scarred. Nevertheless, the internal jugular vein and the carotid artery with the exit of the superior thyroid artery can be visualized. This is further dissected and identified as a suitable connecting vessel. The outlet of the lingual and facial arteries is then identified and ligated. Dorsal to this, the pharyngotomy is performed in the tonsil lumen. This creates a 3-finger wide access into the oral cavity. After exposing the vessels to be anastomized (a deep branch of the internal jugular vein is prepared for the vein), the radial artery flap is lifted from the left forearm. The previously measured defect measures 10 x 6 cm, so that the graft is marked accordingly from the left forearm and lifted in a typical manner with a skin monitor. A tourniquet (300 mm/Hg) is created and skin flaps are prepared. Cut subfascially to the brachioradialis muscle and dissect the lateral cephalic vein distally. Dissection of the distal section of the cephalic vein and now medial to this to locate the radial superficial ramus nerve. This can be exposed and spared. Further subfascial dissection, leaving the peritendineum on the tendon sheaths and exposing the vascular pedicle. Clamping and ligation of the vascular pedicle. Further dissection from ulna to radial and then from distal to proximal with clipping of the feeding and draining vessels. The stalk is always spared. Dissection from distal to proximal and exposure of the transition of the radial artery into the ulnar artery. Also exposing the transition from the deep to the superficial venous system up to the cubital vein. In each case, the venous arterial supply is stopped after opening the tourniquet and careful hemostasis. Both flap perfusion and perfusion of the distal hand are very good. Deposition of the graft and subsequent insertion of the graft from external to enoral via the pharyngotomy. The graft is carefully and completely sutured in place using single button sutures (SA plus 3/0). Cervically, the radial artery is anastomosed with the superior thyroid artery using single button sutures and the vein of the graft with the venous outlet from the internal jugular vein. A 3.0 mm coupler is used for the latter end-to-end anastomosis. The final check of the blood flow reveals an undisturbed flow, so that the skin monitor is now incorporated into the cervical skin with subsequent subcutaneous and skin sutures in a tension-free position of the anostomosis. The final Doppler signals are also very good. Parallel to the incorporation of the graft, <CLINICIAN_NAME> removes a full-thickness skin graft from the right groin. The wound there is primarily closed with subcutaneous sutures and skin sutures. A drain is inserted. Sterile wound dressing. Now incorporation of the free skin graft into the lifting defect on the left forearm. Primary closure of the proximal part of the forearm and incorporation of the free skin into the distal lifting defect. This is performed by <CLINICIAN_NAME>. Finally, incision of the full-thickness skin and application of a vacuum dressing. This should be left in place for 7 days. Vacuum sealing was performed under sterile conditions. Application of a Cramer splint and opening of the vacuum dressing.