Induction of anesthesia and transnasal intubation by the anesthesia colleagues. First, the PEG is inserted. To do this, enter with the flexible esophagoscope and pre-scan into the stomach. No abnormalities here with good diaphanoscopy. Insertion of the PEG using the thread pull-through method through <CLINICIAN_NAME> and <CLINICIAN_NAME>. First, transoral tumor resection is performed after appropriate preparation. After insertion of the retractors, the tongue is disluxed and tumor resection begins with the monopolar caustic technique at an appropriate safety distance. Subsequently, marginal sections are taken from the entire circumference of the resulting defect and examined using frozen section histology, all of which prove to be tumor-free, so that an R0 resection can be assumed. Neck dissection then started on the left side: After skin incision, dissection and fixation of the skin platysma flap. Regions I-V are then removed while preserving all non-lymphatic structures. A passage is created from the transoral resection into the lateral neck. A large caliber jugular vein and the superior thyroid artery are dissected out for anasatomization. Then transition to neck dissection on the opposite side. Here too, all lymph node stations are removed while preserving all non-lymphatic structures. In the meantime, removal of the radialis graft and continuation of the operation by <CLINICIAN_NAME>. <CLINICIAN_NAME> starts lifting the radialis graft from the left forearm. Exposure of the brachioradialis muscle for this purpose. Exposure of the cephalic vein. Exposure of the venous star. Exposure of the venous confluence. Exposure of the radial artery at the exit from the brachial artery. Addition of <CLINICIAN_NAME> and further preparation. Incision of the graft. Exposure of the cephalic vein in the distal area. Dissection of the cephalic vein so that it is still connected to the graft with subcutaneous tissue and can be virtually integrated. Exposure of the superficial ramus of the radial nerve, which has several branches, the branches of which can be preserved. Exposure of the radial artery. Separation of the radial artery and lifting of the graft. Dissection of the pedicle up to the elbow and removal of the graft, taking superficial and deep veins with it. Closure of the arm with split skin in the usual manner using <CLINICIAN_NAME> and <CLINICIAN_NAME>. Suturing of the graft combined transcervically and transorally. This succeeds without any problems. <CLINICIAN_NAME> had already performed a primary suture in the area of the soft palate and the tonsil beforehand. This was completed and then the graft was sutured in place. Removal of the stalk to the left side of the neck. Anastomosis of the radial artery with the superior thyroid artery. Anastomosis of a deep vein to a branch from the facial vein close to the outlet and performance of an end-to-side anastomosis between the internal jugular vein and the point where the cephalic vein joins the venous confluence. Before the venous anastomosis, there was a very good venous return from the deep and also from the superficial system and explicitly also from the cephalic vein. Finally, positioning of the pedicle and inspection of the oral cavity. The graft is well supplied with blood. Puncture the graft, blood comes back. Palpation of the graft. The pulse of the radial artery can be felt. Please check the flap according to the usual procedure. Continue antibiotics for at least 24 hours. Post-operative blue swallow on the 10th day, an X-ray pre-swallow is not necessary.