After appropriate positioning, first perform transoral tumor resection with the monopolar needle. The tumor is successively removed under vision with a safety margin of about 1 cm, ultimately resulting in a hemiglossectomy. Macroscopically and palpatorily, there are no more tumor extensions. When inspecting the specimen, the safety margin in the area of the anterior floor of the mouth is 1 to 3 mm smaller than in the other direction. Therefore, a resection is taken in the area of the anterior floor of the mouth. Subsequently, marginal sections are taken from the entire circumference as well as from the base of the tumor, all of which prove to be free of tumor except for the posterior tumor base. Therefore, in the course of the operation, a large piece of the tongue is resected again in the affected area and then another peripheral incision is taken. Both samples were found to be tumor-free on frozen section histology, so that an R0 resection can now be assumed. This results in an approx. 8 x 8.5 x 5.5 large area to be reconstructed. Subsequent transition to elevation of the radial flap graft from the left forearm. Mark the S-shaped skin incision and the radialis flap to be removed while protecting the retinaculum. Sharply cut through the skin and the subcutis. Push the two muscle bellies apart and expose the very strong vascular pedicle in depth. This is dissected proximally, where a strong cubital vein star is found. In addition, 2 large-lumen veins are dissected, which will later be used for anastomosis. Expose the origin of the radial artery. Then develop the flap distally. Here, after incision on the ulnar side, the flap is developed subfascially from here to the tendon. The radial side of the flap is then also developed, sparing the sensitive radial branch. The flap is now fully developed and is left in situ until both neck dissections have been completed. Once the tumor has been resected, the neck is dissected on the right side through <CLINICIAN_NAME> and <CLINICIAN_NAME> simultaneously with the radial flap elevation on the left forearm. First, make an arcuate incision from the mastoid over the sternocleidomastoid muscle and curved anteriorly back towards the chin. Then dissection through the subcutaneous tissue and the platysma. The platysma is then further dissected upwards subplatysmally. The cervical anus is spared. However, this must be sacrificed later. Sparing of a vein running far anteriorly as a possible vascular connection later. Dissection of the anterior edge of the sternocleidomastoid muscle. Dissection of the omohyoid muscle. Exposure of the posterior digaster venter muscle. Then start with the lateral neck dissection. Dissection of the internal jugular vein and the accessorius nerve. At least 3 to 4 clear metastases can be seen. Removal of the upper neck specimen from level II b. Sparing of numerous accessorius branches. Dissection further caudally. Protection of the plexus branches. Then complete removal of the lateral neck preparation. Subsequent removal of the anterior neck preparation including level I a, i.e. subcutaneous tissue with lymph nodes up to the opposite left digaster venter anterior muscle. Exposure of the submandibular gland. Exposure of the vessels leading to the submandibular gland. Subsequent sharp exposure of nerve branches that run from the lingual nerve to the gland. Ligation of the Wharton's duct and complete removal of the gland. Then clearing of level II with at least one suspicious lymph node below the mandible. Subsequent preparation of possible connecting vessels for the radial artery flap, including the superior thyroid artery. Subsequently handover of the operation to <CLINICIAN_NAME>. The undersigned <CLINICIAN_NAME> then also performs the neck dissection on the left side. Here too, lymph node regions I to V are successively removed. There are clinical signs of metastasis in almost all regions. The jugular vein is not thrombosed, but in the middle section in the region of region III it is somewhat weak in caliber, otherwise freely pervious. Dissection of the superior thyroid artery, which will later serve as an anastomosis. There is no facial vein as such, nor is there a large-volume inflow to the internal jugular vein, so that an end-to-side anastomosis will be performed for microvascular venous anastomosis. The radial artery flap graft is then harvested from the left forearm. This is pulled through the access created in the floor of the mouth to the left side of the neck and sutured into the area of the defect. The flap is then microvascularly anastomosed, whereby the radial artery is connected to the superior thyroid artery. The venous anastomosis was performed directly to the internal jugular vein in the end-to-side anastomosis. At the final check, the anastomoses are freely patency. In addition, the stalk is loosely fixed to the surrounding muscle tissue with 2 Vicryl sutures. Insertion of a Redon suction drain and a flap. Suturing of the two neck dissection incisions on the neck. Subsequent removal of an 8 x 5 cm split-thickness skin graft from the right thigh by <CLINICIAN_NAME>. The defect in the area of the left forearm is treated with this split-thickness skin. Finally, perform the tracheotomy of the visor. After sharp transection of the cutis and the subcutaneous fatty tissue, the prelaryngeal musculature in the linea alba is pushed apart. After dissection, the thyroid isthmus is clamped off on the pretracheal lamina, cut off and pushed to the side. The trachea is then opened between the 3rd and 4th tracheal clasps. Completion of the mucocutaneous anastomosis and easy insertion of an 8-gauge tracheostomy tube, onto which the patient is then intubated. Finally, the arm and thigh dressing is applied. Sterile wound dressing in the neck area. End of the operation and handover of the patient to anesthesia. Addendum: Macroscopically, there was evidence of clinical metastasis on both sides of the cervix, so that adjuvant radiochemotherapy will be indicated subsequently.