Induction of anesthesia and transnasal intubation by anesthesia colleagues. PEG insertion: insertion of the esophagoscope into the stomach. No abnormalities found during a thorough examination. After diaphanoscopy, insertion of a 15 mm abdominal wall tube in a typical manner without complications. Fixation to the abdominal wall in the typical manner. Entry with the Kleinsasser tube and inspection of the tumor region. Insertion of the McIVOR oral spatula and inspection of the tumor region. The tumor starts on the soft palate parauvularly on the right and extends over the tonsillar lobe to the base of the tongue, it also grows into the edge of the tongue on the right side. Now sterile washing and draping. Start with transoral tumor resection. Here the operation is performed with an electric needle and partly with scissors and bipolar forceps. In the area of the base of the tongue, the overview is so difficult that it is no longer possible to operate transorally. Now create an apron flap and expose the sternocleidomastoid muscle, omohyoid muscle and submandibular gland. Exposure of the cervical vascular sheath and exposure of the hyoid bone and continuation of the tumor resection from transcervical. To do this, the digastric muscle must be cut and the tumor must be luted through from transoral to cervical. Then successively cut around the tumor in the tongue base area so that the tumor can be completely resected en bloc with a safety margin of 1.5 cm. The tumor preparation is placed on cork and marked as a whole for frozen section. All tumor margins are assessed as free. Now complete the neck dissection on the right side. For this, free preparation of the internal jugular vein, the facial vein and the external jugular vein. There are several large metastases in level II a and b. Part of the cervical plexus must also be removed as the metastases are fused to it and the accessorius cannot be preserved either. The border cord of the vagus nerve and the hypoglossal nerve can be preserved. Then send in the neck dissection level individually as part of the lymph node study. On the opposite side, neck dissection by <CLINICIAN_NAME>. The sternocleidomastoid muscle is also visualized for this. Exposure of the omohyoid muscle and the submandibular gland. Dissection of the internal jugular vein. Exposure of the hypoglossal nerve, the accessorius nerve and clearing of the neck levels II a to V a while sparing the plexus branches. The neck levels are also sent in individually as part of the lymph node study. Repositioning for tracheotomy. Perform a visor tracheotomy between the second and third tracheal cartilage through <CLINICIAN_NAME> and create a mucocutaneous anastomosis. Lifting of the radialis graft by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Parallel to this, lift the split skin from the right thigh with the dermatome 7.5 mm. Then dissection of the neck vessels under the microscope on the right side. The external jugular vein, the facial vein with one outlet and the superior thyroid artery are dissected. The lingual artery was resected as part of the tumor resection and is dissected as a stump for the anastomosis. Then transfer of the operation to <CLINICIAN_NAME>. Elevation of the radialis graft: Marking of the graft (6 x 11 cm) on the distal forearm. Incision of the graft and transection of the cutaneous and subcutaneous tissue and the forearm fascia. Exposure of the confluence in the crook of the elbow and dissection along the cephalic vein to the radial flap edge. Integration of the cephalic vein into the graft. Raise the cephalic vein and expose the external ramus of the radial nerve. Ulnar preparation subfascially up to the flexor carpi radialis muscle. Locate the distal stump of the radial artery. Undermining with a clamp and clamping of the radial artery. A good perfusion signal can be recorded the entire time. Dissection of the radial artery and ligation of the stumps. Elevation of the radial artery flap from the wound bed, with constant bipolar coagulation of smaller vessels and placement of vascular clips. This is done while protecting the radial nerve. Dissection of the blood vessels in the crook of the elbow and removal of the flap, first of the artery and then of the vein. Lifting of the graft without complications. Wound closure using split skin from the lower leg by <CLINICIAN_NAME>. Then insertion of the radial flap: The radial flap is inserted into the defect and successively sutured into the defect both transcervically and transorally, partly with the sutures in place. This is achieved without tension using 3-0 Vicryl single-button sutures followed by dissection of the superior thyroid artery and an outlet from the internal jugular vein as well as dissection of the external jugular vein. All vessels are conditioned for vascular anastomosis. After conditioning the radial artery anastomosis, this is then connected to the superior thyroid artery. After opening the clamps, good arterial flow, good venous return. Then conditioning of the cephalic veins. One is anastomosed with the external jugular vein using a 3.5 mm vessel coupler. After opening the clamps, good venous return, positive smear phenomenon. The second smaller part of the superficial venous outflow is anastomosed with the outlet from the internal jugular vein using a 2-0 coupler. Here too, good venous return after opening the clamps. Positive smear phenomenon. A small outlet, which corresponds to the confluence, is clipped. Subsequent careful hemostasis. Inspection of the flap shows good perfusion. Extensive irrigation and hemostasis. Wound closure in layers and epithelialization of the tracheostoma, insertion of a Redon drain on the left and 2 flaps on the right. The forearm was treated in the typical manner with a Mepilex swab dressing and fixed and attached to a Cramer splint. A hydrogel dressing was applied to the thigh area. The tracheostomy tube was fixed with sutures. The procedure was completed without complications. The patient was admitted to the intensive care unit for postoperative monitoring. Please continue the antibiotic treatment started intraoperatively for approx. 1 week. Nutrition via the inserted PEG tube for 7-10 days. Then gruel and, if necessary, build up the diet. Monitoring of the flap for 5 days by Doppler or clinically. Heparin 500 E/h as a perfusor for 5 days. After receiving the final histology, presentation at the interdisciplinary tumor conference.