<CLINICIAN_NAME>: Initial inspection of the primary tumor region. A partially exulcerated, largely submucosal tumor of the left tonsil is seen. The tumor extends over the entire tonsillar lobe and just behind the lower jaw, but can just be moved here. Infiltration of the posterior palatal arch. Overall extensive mass. A good 5 x 4 cm in total. T3 stage due to its size. The tumor is now resected with an electric needle. Resection up to the parauvular level. Complete removal of the anterior palatal arch and towards the ascending mandibular branch. Successive lateral detachment using the dissection technique. Infiltration of the pharyngeal musculature. Resection of almost the entire parapharyngeal musculature. Here, broadly exposed neck fat tissue with vessels underneath. Exposure of the pterygoid musculature. No infiltration here. Complete involvement of the posterior palatal arch. Exclusion of infiltration towards the nasopharynx. Caudal resection beyond the tonsil lobe and removal of the tumor macroscopically in toto on the specimen. Now removal of marginal samples completely on the specimen. These are completely free of carcinoma, only in the area of the posterior pharyngeal wall is there still circumscribed CIS. A resection is performed here. Overall R0 situation. Now turn to the neck dissection of the left side. Here cN2b neck status. Skin incision at the anterior edge of the sternocleidomastoid muscle. Cut through skin and subcutaneous tissue. Exposure of the sternocleidomastoid muscle. Exposure and later ligation of the external jugular vein. Preservation of the auricular nerve. Exposure of the omohyoid muscle. Release of the submandibular gland and exposure of the digastric muscle. Spinal mass in level II in particular. Release of the anterior neck preparation with careful protection of the superior thyroid artery. Supply and occlusion of the facial vein. Exposure and preservation of the facial and lingual arteries. Exposure of the accessorius nerve, which can be preserved. Free dissection of the internal jugular vein, later completion of the accessorius triangle and level V while carefully preserving the cervical plexus branches, the vagus nerve and the common carotid artery. Finally, the digastric muscle is resected and broken through enorally. Creation of a tunnel measuring 3 transverse fingers. Insertion of moist drapes and turning to the opposite side. The procedure is basically the same here. Incision at the anterior edge of the sternocleidomastoid. Exposure and preservation of the sternocleidomastoid muscle, external jugular vein and auricular nerve. Exposure of the omohyoid muscle, the submandibular gland and the digastric muscle and exposure and preservation of the facial vein, superior thyroid artery, cervical artery and hypoglossal nerve. Clearing out the anterior neck preparation. Exposure of the accessorius nerve. Free preparation of the internal jugular vein. Circumscribed clearing of the accessorius triangle and completion in the direction of level V with careful protection and .............................. of the extent in the direction of the cervical plexus. Exposure and preservation of the common carotid artery and vagus nerve. Subsequent careful wound inspection. Insertion of a 10-gauge Redon drain and careful, two-layer wound closure. Plastic tracheotomy: Horizontal incision at the level of the cricoid cartilage. Cut through the skin and subcutaneous tissue. Exposure of the infrahyoid musculature. Exposure of the cricoid cartilage. Exposure of the thyroid isthmus. Supply of the thyroid isthmus and transection. Insertion between the 2nd and 3rd tracheal ring while performing a visual tracheotomy. Subsequent insertion of the tracheostoma in the usual manner while performing the mucocutaneous anastomosis. Finally, problem-free transfer to a size 8 low-cuff cannula. <CLINICIAN_NAME>: First, preparation of the arm. Marking of the radialis graft, which is 12 x 8 cm in size with a bulge for the soft palate duplication. First mark the graft. Marking of the full-thickness skin donor site on the proximal forearm for primary defect coverage at the graft site. Trimming of the full-thickness skin. Lifting the full-thickness skin. Asservation of the full-thickness skin. Incision of the graft and exposure of the brachioradialis muscle. Exposure of the cephalic vein. Exposure of the superficial radial ramus nerve, which splits into two branches. Both branches can be visualized and preserved. Exposure of the radial artery, which is extremely lateral in this patient. Ligation and separation of the radial artery in the distal area. Exposure of the tendon level. Integration of the cephalic vein into the graft. Lifting the graft from the tendons. This reveals the ulnar artery, which can remain completely intact. Lifting of the radialis pedicle in the usual manner. Dissection of the venous star in the crook of the elbow. There is good venous confluence between the superficial and deep venous system. Both a superficial and a deep vein are prepared as a venous connection vessel. Deposition of the graft. Attempt at primary wound closure on the proximal part of the forearm. This is not completely successful. Incision of the full-thickness skin into the graft donor site and residual full-thickness skin coverage in the proximal area of the forearm. Application of Mepilex and sterile wound dressing. Application of a dorsal forearm splint. Insertion of the graft into the defect with doubling of the soft palate through <CLINICIAN_NAME>. The stem is diverted to the left. Creation of the vascular anastomosis by <CLINICIAN_NAME>, initially on the left side via the stump of the superior thyroid artery. Suturing the anastomosis is very difficult as the flap vessel is covered with cholesterol-containing material and the individual wall layers no longer adhere well to each other. The patency of the flap stalk is difficult. Initially there is an acceptable flow via the superior thyroid artery, which then stops abruptly so that this vascular anastomosis has to be removed again. Unfortunately, there is no longer a corresponding vessel on the left side, as the vessels in question are all calcified or interspersed with whitish material containing cholesterol. A tunnel was therefore created to the right side of the neck. The superior thyroid is shown here. Dissection of this and anastomosis with the flap vessel. Good blood flow can be established. Connection of the venous vessels, once to the facial vein and once to a vein accompanying the facial vein. Control of flap blood flow. Good flap perfusion. If there are signs of compartment syndrome on the left forearm, please consult the surgeon and open the wound. No oral food for 10 days. Then X-ray pre-swallow and oral food build-up.  