Transferring the patient to the operating theater and positioning the patient. Introductory consultation with anesthesia and team time-out. Start tracheotomy after transoral intubation. Sterile abjoration and draping after injection of suprarenin with lidocaine, horizontal incision, dissection through the subcutaneous fatty tissue and dissection through the prelaryngeal muscles. Identification of the thyroid gland and transection of the thyroid gland in the middle with careful and successive coagulation. Exposure of the trachea and blunt dissection using a pedicle. Now enter between the 2nd and 3rd tracheal cartilage, create a visor tracheotomy. Suturing in the usual manner. Now place the PEG system, this is easily achieved with good diaphanoscopy using the thread pull-through method. Now sterile abjodation and covering and start with the transoral tumor resection. The tumor is resected at a distance of 1 cm, the extent of the tumor affects the floor of the mouth on the right side, the alveolar ridge on the right side (however, the tumor can be easily pushed away from this using Freer), there is no evidence of bone erosion. The glossotonsillar groove on the right side extends almost into the left glossotonsillar groove. The tumor extends caudally into the vallecula. The right lingual artery is ligated. On the left side, a pulsating vessel is still palpable in the depth, even after resection, 'so that the left side of the tongue should still be supplied. Due to the size of the tumor and a palpable cone extending both laterally and caudally, now combined transoral, transcervical resection. Skin incision and dissection through the fatty tissue, dissection through the platysma. Now subplatysmal dissection and finding the anterior margin of the sternocleidomastoid muscle. Expose the anterior border of the sternocleidomastoid muscle and find the omohyoid muscle. Cranial dissection. Exposure of the accessorius nerve and the posterior vein of the digastric muscle. It can be seen that the tumor extends into the submandibular lobe and has a medial extension to the pharyngeal tube. Pull through technique of the tumor. Submandibulectomy on the right. Further successive dissection of the tumor at a distance of approx. 1 cm from the surrounding tissue. The tumor can be completely removed. After suture marking, the tumor is sent for frozen section. The tumor is resected R0 on the specimen. The pharyngeal flap is opened and sutured using single button sutures. Now complete the neck dissection on the right side. Exposure of the neck-vascular sheath and identification and protection of the vagus nerve. Successive removal of the lateral and medial neck preparation. Exposure of the hypoglossal nerve and protection of this. Dissection of the facial artery and removal of this for anastomosis. Neck dissection on the left side. Skin incision and dissection through the subcutaneous fatty tissue, dissection through the platysma. Now subplatysmal dissection and discovery of the anterior border of the sternocleidomastoid muscle. Expose the anterior border of the sternocleidomastoid muscle and find the omohyoid muscle. Cranial dissection. Now expose the submandibular gland and pull the submandibular gland cranially with the Langenbeck to protect the marginal ramus. Locate the posterior venter of the digastric muscle. Blunt dissection using a finger and clamp posteriorly in level IIb and finding the digastric muscle here too. Finding and preserving the accessorius nerve. Free preparation of the digastric muscle and knocking down the neck preparation. Now dissect along the cervical vascular sheath in a cranial direction. Here both the facial and external jugular veins are ligated and the common and external carotid arteries are exposed. Identification of the hypoglossal nerve and preservation of this. Successive removal of the lateral and medial neck preparation with preservation of the ansa and brachial plexus. The vagus nerve can also be identified and spared. There is no evidence of a chyle fistula. Now expose the ramus marginalis, the facial nerve and dissect anteriorly. Expose the submandibular gland and remove it. Ligation of the facial artery and the duct. Protection of the lingual nerve on the left side after submandibulectomy. Now successive removal of Level Ia and b so that Level Ia and b, Level IIa and b, III, IV and V have been removed in total. If there is no indication of increased bleeding, irrigation of the neck and insertion of a Redondra ring. Two-layer wound closure. Elevation of the radialis graft by <CLINICIAN_NAME> and <CLINICIAN_NAME>: Palpatory identification of the distal radial artery. Marking of the flap borders (14 x 6 cm) on the distal forearm, proximal to the flexor retinaculum, with an S-shaped incision running proximally into the cubital fossa. Incision of cutaneous and subcutaneous tissue starting proximally. Identification and visualization of the venous confluence in the cubital fossa. Identification of the cephalic vein and dissection of the vein distally with integration into the radial graft margin. Identification of the ramus externus of the radial nerve and elevation of the radial portion, leaving the peritendineum of the tendons of the brachioradialis muscle intact. Subsequent ulnar incision down to the forearm fascia. Incision of the fascia and subsequent subfascial elevation of the ulnar edge of the graft up to the tendon of the flexor carpi radialis muscle. Care is taken to leave the peritendineum on the flexor tendons and to spare the ulnar artery. Identification of the distal radial artery and trial clamping with a vascular clamp. After 5 minutes with good oxygen saturation measured by pulse oximetry (measured on the index finger), the vessels are removed with subsequent ligation (Prolene 6.0). Successive detachment of the flap pedicle from the M. pronator quadratus and M. flexor pollicis longus with ligation of the outgoing perforators using a vessel clip into the cubital fossa. Exposure and protection of the radial nerve on the medial side of the brachioradialis muscle. Exposure of the brachial artery, V. mediana cubiti, A. ulnaris. First removal of the radial artery, then of two veins of the superficial venous system. Vascular ligation by means of a bypass ligature (artery) and vascular clip (veins). Subtle hemostasis in the area of the wound bed using bipolar coagulation forceps. Two-layer wound closure in the area of the proximal forearm. Covering of the graft bed with split skin from the right thigh in the usual manner. Suturing of preparation swabs. Application of a wound dressing and a forearm splint. Completion of the graft lift without complications. Now pulling the flap through enorally and suturing the flap to the defect in the usual way with Vicryl 4-0 single-button sutures. Now inspect the vessels. It can be seen that the facial artery on the right side is thrombosed even after cutting it back. Ligation of this and free preparation of the superior thyroid artery. Connection of the radial artery to the right superior thyroid artery in the usual manner. Suturing of 2 veins end-to-side to the internal jugular vein. Positioning of the pedicle and suturing using Vicryl sutures. Good aspect. Insertion of a Redon drainage and a flap as well as two-layer wound closure. Final consultation with the anesthesiologist, reintubation and completion of the operation.