Induction of anesthesia and intubation by the anesthesiology colleagues, then the PEG is inserted first. For this purpose, the flexible oesophagogastroscope is used to enter the stomach. The mucosa is unremarkable. If the diaphanoscopy is good, the PEG is inserted using the thread pull-through method without complications. Repositioning and insertion of the spandex and a covered wound blocker. Inspection of the tumor region. The tumor is located in the area of the glossotonsillar groove on the left, merges into the base of the tongue, merges onto the alveolar ridge of the lower jaw and merges into the lateral floor of the mouth. Now snare the tongue and start resecting the tumor in the tongue area with the monopolar needle. The tumor is cut around the edge of the tongue up to the base of the tongue. The tumor is then cut around in the area of the floor of the mouth and the side wall of the pharynx. Then push the tumor away from the lower jaw in the area of the alveolar ridge. This was successful without any problems. Extension of the resection in the area of the glossotonsillar groove. Although the mouth opening is very small, it is possible to resect the tumor completely transorally with maximum relaxation and opening of the mouth. The tumor is retrieved en bloc. Subsequent resections are performed in the area where the tumor is macroscopically close to the resection margins. At the end, marginal samples are taken and the tumor specimen is sent in thread-marked. All marginal samples are free of tumor, carcinoma and dysplasia in the frozen section. Now measure the defect and proceed to neck dissection. At the same time, the radialis graft is lifted by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Lifting of the radialis flap using <CLINICIAN_NAME> and <CLINICIAN_NAME>: Marking of the graft in the presence of <CLINICIAN_NAME>. Skin incision along the previously defined flap boundaries and S-shaped skin incision into the antecubital fossa. Dissection through the subcutaneous tissue, initially in the area of the flap pedicle down to the forearm fascia. Identification of the superficial cutaneous veins. Identification of the cephalic vein and dissection of the vein. It can be seen that the vein can be included in the skin graft on the radial side. After inspecting the superficial venous situation, the forearm fascia is incised along the flexor carpi radialis muscle and the brachioradialis muscle in a distal direction. The forearm fascia is then incised in the area of the flap edges. In this case, the ulnar fascia is first dissected subfascially, leaving the peritendineum and perimysium of the adjacent muscles and tendons of the forearm intact. Identification of the ulnar artery. This can be left uninjured without any problems. Distal skin incision through the forearm fascia and subfascial dissection up to the anterior edge of the flexor carpi radialis muscle. Radial incision with inclusion of the cephalic vein in the graft. Here too, subfascial dissection is performed up to the anterior edge of the brachioradialis muscle. Particular care is taken here to preserve the superficial ramus of the radial nerve. Identification of the distal radial artery. Undermining of the radial artery with the clamp and clamping of the artery. After clamping the radial artery, there is no decrease in oxygen saturation (measured on the index finger). After approx. 5 minutes, the distal radial artery is severed and the stumps are supplied with a bypass ligature. The radial artery flap is now lifted from the depth alternately from the radial and ulnar side along the septum under constant bleeding control using the bipolar coagulation forceps and clip supply. After insertion of a proximal retractor between the muscle bellies of the .............................. carpi radialis and brachioradialis muscles, the flap pedicle is also dissected. The radial nerve can be spared here. The radial nerve can be spared. Dissection is carried out up to the confluence of the veins and up to the exit of the interosseous artery. The artery is also clamped with a clip for a few minutes. Here, too, there is no decrease in oxygen saturation (measured on the index finger). Once the interosseous artery has been ligated and ligated, the flap can be lifted without any problems. The wound is closed in two layers in the area of the S-shaped skin incision on the flap pedicle and split skin is sutured in the area of the former skin flap. The split skin is sutured in place with Ethilon 5.0 in single button sutures. Exposed tendons are covered with muscle tissue beforehand. Preparation swabs are attached to the split skin with deep skin sutures to fix the split skin graft to the substrate. This is followed by the application of a wound dressing with absorbent cotton and the application of a dorsal splint in a slightly extended position of the wrist as well as the application of a flexible bandage. Completion of flap elevation without complications. Start with neck dissection on the left side. Skin incision in a transverse skin fold. Exposure of the platysma. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the digastric muscle and the submandibular gland. Overall difficult preparation conditions as the neck is very voluminous and short. Exposure of the nervus accessorius and the cervical vascular sheath. The hypoglossal nerve and the lingual artery were already removed during the tumor resection. Now remove the neck specimen II a to V a while sparing the plexus branches. This causes the internal jugular vein to tear due to traction. This is carefully sutured over so that further flow is possible. As an anatomical variation, the facial vein emerges directly from the external jugular vein and the internal jugular vein has no further outlets in the area of the aforementioned level. Now remove the submandibular gland and clear level I b. Cut through the digastric muscle and create an enoral tunnel so that 3 transverse fingers can fit through. Now turn to the neck dissection on the opposite side. Here also skin incision in a transverse skin fold. Exposure of the sternocleidomastoid muscle, the omohyoid muscle, the digastric muscle and the submandibular gland. Then evacuation of neck levels II a to V a, sparing the plexus branches and hypoglossal nerve and the accessorius and cervical nerves. Here, too, the internal jugular vein is torn by hook traction. The entire venous tissue is extremely fragile. Unfortunately, it is not possible to close the tear of the internal jugular vein on the right side by suturing it over. Recall from <CLINICIAN_NAME>. Ultimately, the internal jugular vein must be completely closed above an outlet and ligated. Then insertion of Tabotamp and completion of the neck dissection. Dissection of the superior thyroid artery and the facial vein and external jugular vein for flap connection. Removal of the radialis graft. It can be seen that although there is a good radial artery on the radialis graft itself, the venous situation is extremely critical. There are 2 tiny concomitant veins and a slender venous confluence between the superficial and deep system. In the end, the decision is made to use the radialis graft anyway. It is now sutured in place by placing sutures in the deep area of the oropharynx in the area of the base of the tongue and the side wall of the pharynx. The graft is then successively retracted and finally sutured in the area of the soft palate, the cheek and the anterior part of the edge of the tongue. The stalk is transferred to the right side and anastomosed with the superior thyroid artery and the facial vein and a further outlet from the facial vein. In the meantime, the tracheotomy was performed using the visor technique. At the end, a Redon drain was inserted on the left side and a flap on the right side. The patient went to the intensive care unit on a ventilator and was to continue antibiotics for at least 24 hours. The patient's diet should be resumed from the 14th postoperative day at the earliest.