Induction of anesthesia and intubation transnasally by the anesthesia colleagues. Insertion of the McIvor oral spatula and inspection of the tumor. The tumor is in the area of the glossotonsillar groove, extends to the anterior palatal arch and to the alveolar ridge of the mandible on the right. Start with tumor resection in the area of the anterior palatal arch parauvularly. Continue in the area of the alveolar ridge, then in the area of the tonsillar loge and in the base of the tongue. The tumor is removed en bloc with a safety margin of 1 cm on all sides. The tumor is then thread-marked and needle-marked and placed on cork for a frozen section. All margins free of tumor and carcinoma in situ. Measurement of the defect, 6 x 8 cm. Radialis flap left, elevation of the graft (<CLINICIAN_NAME>) Sterile ablation and covering of the left arm. Marking of the flap and landmarks. Checking the pulse oximeter. Skin incision and dissection through the subcutaneous fatty tissue. Exposure of the cephalic vein and dissection on the cephalic vein and laterally from this onto the muscle. Exposure of the venous confluence in depth. Dissection of the flexor carpi radialis muscle and the muscle belly. Dissect the cephalic vein and enter between the two muscle bellies. Now closely dissect the muscle bellies in depth and locate the vascular pedicle. This pulsates well. Careful dissection of both the brachioradialis muscle and the flexor carpi radialis muscle. Now cut around the ulnar side of the flap, dissect through the fascia and lift the musculofascial flap up to the tendon of the flexor carpi radialis muscle. Suture the fascia to the graft to avoid shearing. Now further dissection of the lateral cephalic vein caudally and inclusion of the cephalic vein in the graft. Here 2 lateral branches are cut off. Dissection of the musculocircular flap also from the radial side while sparing the sensory branch of the radial nerve. Identification of the radial artery caudally. Further preparation of the vascular pedicle and dissection of the vascular pedicle from the surrounding tissue with bipolar coagulation and multiple clips for the perforator vessels. Now lift off the complete flap graft in the case of vessels left in situ in the sense of the radial artery and the cephalic vein. Dissection of the superficial and deep veins as well as the branch of the radial artery from the brachial artery. Separation of the radial flap and ligation of the venous vessels with zero ligatures and the arterial vessels with silk. Careful hemostasis is performed. The split skin is then lifted from the right thigh and the split skin is sutured in the usual manner and the arm is closed in two layers. The pie crust was applied and a pressure bandage and plaster cast were applied to immobilize the arm. Saturation was stable at over 93% throughout the operation and remained stable even after removal of the radial artery, Allen test negative. Neck dissection performed by <CLINICIAN_NAME>: Neck dissection first performed on the left side, region Ib to V. S-shaped skin incision on the anterior border of the sternocleidomastoid muscle approx. 2 QF below the mandible. Separation of the cutaneous/subcutaneous tissue. Separation of the platysma. Subplatysmal dissection of the skin flap ventrally and dorsally. Identification of the anterior border of the sternocleidomastoid muscle and dissection in depth to expose the plexus branches of the cervical plexus. Now identification of the omohyoid muscle. Dissection of the omohyoid muscle from lateral inferior to medial superior up to the hyoid bone. Insertion of the inferior round ratchet. Identification of the submandibular gland and elevation of the gland to locate the digastric muscle. After free preparation of the venter posterior digastric muscle and insertion of the wide retractor under the muscle (Langenbeck). Now identify the accessorius nerve and free dissection from the neck tissue. Now sharp dissection along the internal jugular vein from caudal to cranial and lateral displacement of the neck dissection. Sharp dissection along the vein and freeing of the neck preparation from the cervical vascular nerve sheath. Separation of the neck dissection from the deep cervical fascia from cranial to caudal while preserving all nerve and vascular structures. Now elevation of the entire submandibular gland and removal of the lymphatic tissue in the area of region Ib. Two-layer wound closure after insertion of a Redon drainage and completion of the neck dissection on the left side without complications. Now turn to the right side. First perform the neck dissection on the right side region Ib to V. S-shaped skin incision on the anterior border of the sternocleidomastoid muscle approx. 2 QF below the mandible. Separation of the cutaneous/subcutaneous tissue. Separation of the platysma. Subplatysmal dissection of the skin flap ventrally and dorsally. Identification of the anterior border of the sternocleidomastoid muscle and dissection in depth to expose the plexus branches of the cervical plexus. Now identification of the omohyoid muscle. Dissection of the omohyoid muscle from lateral inferior to medial superior up to the hyoid bone. Insertion of the inferior round ratchet. Identification of the submandibular gland and elevation of the gland to locate the digastric muscle. After free preparation of the venter posterior digastric muscle and insertion of the wide retractor under the muscle (Langenbeck). Now identify the accessorius nerve and free dissection from the neck tissue. Now sharp dissection along the internal jugular vein from caudal to cranial and lateral displacement of the neck dissection. Sharp dissection along the vein and freeing of the neck preparation from the cervical vascular nerve sheath. Separation of the neck dissection now also from the deep cervical fascia from cranial to caudal while preserving all nerve and vascular structures. Dissection close to the gland and release of the submandibular gland from its glandular bed. Ligation of the Wharton's duct. Separation of the submandibular gland. Now also sharply cut through the digastricus venter posterior muscle and the stylohyoid muscle. This creates an opening in the oropharynx that is over 3 fingers wide. The connecting vessels are then exposed. The lingual artery and the superior thyroid artery are freed from the surrounding tissue. For the vascular anastomosis, the superior thyroid artery is selected and exposed. The flap graft is inserted pharyngeally. First adaptation of the cranial flap edge with the pharyngeal mucosa from the enoral side. Finally, several sutures are placed and the graft is sutured from the cervical side in the area of the caudal edge of the graft. Perform the vascular anastomosis using the superior thyroid artery and end-to-end anastomosis using single button sutures to the flap artery. Perform venous anastomosis using two end-to-side anastomoses to the internal jugular vein using a single-button technique. With good diaphanoscopy, problem-free PEG insertion using the thread pull-through method. At the end, insertion of an easy-flow drainage and two-layer wound closure after subtle hemostasis using bipolar coagulation forceps and multiple wound irrigation.