Start of the operation with positioning of the patient and inspection of the oral cavity after insertion of the mouth retractor. This reveals an exophytic process of the right tonsil lobe, which completely infiltrates the soft palate, extends beyond the midline and also infiltrates the tonsil on the left side. The resection margins are then marked with the monopolar coagulation needle. Subsequently, sharp dissection starting at the soft palate, first to the right tonsil lobe. With careful hemostasis, the right tonsil is then removed in the sense of a tumor tonsillectomy with a sufficient safety margin. Here, with recurrent bleeding, difficult surgical conditions. Then dissection from the midline to the left side. Here too, tumor tonsillectomy with sufficient safety margin. The specimen is then removed in toto and sent in for pathological examination with a suture marker. This is followed by several marginal samples in the area of the anterior and posterior palatal arch and at the transition from the soft palate to the hard palate, which are then sent for frozen section diagnostics. This is followed by careful hemostasis. Inspection of the resulting defect. Virtually the entire anterior palatal arch of both tonsillar arches is missing, including the uvula and the subtotal soft palate. After the quick incisions were made, all of which were tumor-free, the decision was made to plan the defect coverage using a radial flap from the right forearm. Preoperatively, the vascular status was determined using an elliptical test and radialis Doppler. As the patient is left-handed, the decision was made to use the radial artery flap on the right side if the vascular status of the right forearm was good enough. The patient was then repositioned for tracheotomy. Transverse incision about 1 cm below the cricoid cartilage. Then dissect in layers in depth and expose the prelaryngeal neck veins and muscles. After ligating the neck veins, dissect the prevertebral musculature in the midline. After layer-by-layer dissection in depth, expose the thyroid isthmus. This is first clamped off with 2 Pean clamps and then, after severing, interrupted. Now dissect the anterior wall of the trachea. Then enter the trachea between the 2nd and 3rd cricoid cartilage. After creation of the Björk flap, epithelialization of the tracheostoma. After careful hemostasis, reintubation of the patient onto the tracheostoma. The patient is then repositioned for neck dissection, initially on the right side. To do this, make a skin incision along the sternocleidomastoid muscle. Then dissection of the front edge of the muscle and layer-by-layer dissection in depth. Expose the cervical vascular sheath. Then expose the omohyoid muscle caudally and the digaster venter posterior muscle cranially. Then locate the accessorius nerve. While preserving all outlets of the cervical vascular sheath, dissect the lateral neck preparation. Then clearing of the lateral neck triangle and the anterior neck preparation. Here too, all branches of the external carotid artery and the jugular vein can be preserved. The vagus nerve can also be visualized in its entire course in the cervical vascular sheath. After careful hemostasis and irrigation of the wound, proceed to neck dissection on the left side. The procedure is identical here. Here too, a skin incision is made along the sternocleidomastoid muscle. After exposing the anterior margin, dissection in layers in depth, where the cervical vascular sheath is then located. Then dissect caudally to the omohyoid muscle and cranially to the digaster venter posterior muscle. Here too, the lateral neck preparation is then developed while sparing the cervical vascular sheath and the vagus and accessorius nerves. Also in the lateral neck triangle, develop the neck preparation while protecting the branches of the external carotid artery and jugular vein. Exposure of the hypoglossal nerve in depth, as on the opposite side. This is also intact in its course after dissection. The anterior neck preparation is then also developed without any problems. After careful hemostasis and irrigation of the wound, insertion of a Redon drain and multi-layer skin closure. Now reposition the patient again to elevate the radial flap. First mark the flap after feeling for a good radial pulse. Then cut around the skin flap and make an S-shaped incision on the forearm. First locate the proximal part of the radial artery, just behind the exit of the interosseous artery. Then successive dissection of the artery and the accompanying veins distally. Then develop the myofascial skin flap from ulna to radial. All tendons of the fingers and wrist flexors are preserved here. The distal radial artery is then removed under pulse oximetric control. There is no drop in oxygen saturation, which is measured pulsoxymetrically on the index finger of the right hand. Then carefully and completely lift the radial artery flap while carefully stopping the bleeding. Then remove the vascular pedicle caudal to the interosseous artery. Now perforate the floor of the mouth caudal to the digaster venter posterior muscle at the posterior edge of the submandibular gland. A sufficient muscle gap is created here so that the flap pedicle can pass through easily and without crushing. At the same time, split skin is lifted from the groin on the right side to cover the defect in the forearm. Careful skin closure of the s-shaped skin incision on the forearm. Primary skin closure is made possible in the groin after skin mobilization. After insertion of a Redon drainage, this is done here with single button sutures. The split skin is then sutured to the forearm. The dressing is then applied to both the groin and the forearm. Now suture the flap pedicle. To do this, dissect the superior thyroid artery. After clamping the artery, the artery is removed. An end-to-end anastomosis is then made between the radial artery and the thyroid artery. These correspond very well to each other in terms of caliber. A regional vein is then selected in the area of the upper pole of the thyroid gland, which is placed in the area where it opens into the internal jugular vein, also after clamping. An end-to-side anastomosis is then created between the outflow vein of the flap and the internal jugular vein. The flap pedicle is then well perfused after opening the clamps. Checking the flap enorally also shows good perfusion. A sufficient pulse can be felt in the flap pedicle. Suturing of a wound flap and multi-layer wound closure of the neck dissection wound on the right side. The patient is then repositioned and the mouth retractor is inserted. Circular incision of the radial flap paramedian on the right side. The right tonsil lobe is completely covered by the flap. The remaining remnants of the anterior and posterior palatal arch are sutured together in the area of the left tonsillar lobe. The result is a beautiful reconstruction of the soft palate. Care is also taken in the dorsal part to ensure that the tubal bulges remain free during suturing and that a nasopharyngeal passage is also made possible. Once the procedure is complete, the wound is left dry. The patient is then transferred to the intensive care unit for monitoring by the anesthesia team while breathing spontaneously.