After appropriate preparation, start with the tracheostomy. After skin incision, preparation of the anterior tracheal wall. Opening between the 2nd and 3rd tracheal clasp. Insertion of the mucocutaneous anastomosis. Subsequent retubation of the patient. Then start with the transoral tumor resection. After exposure of the tumor, which has invaded the left posterior palatal arch and extends just to the uvula, it is resected. The resection includes the uvula on the right side and extends upwards to about 1 cm to the hard palate. The entire left soft palate is then successively removed under visualization up to the middle tonsil pole. The specimen is then sent in oriented on a cork plate for a frozen section histological examination. Here, the left margin in the area of the tonsil lobe is still affected by CIS, as is the resection margin in the area of the posterior hypopharyngeal wall. Large resections are taken, which subsequently prove to be tumor-free. Subsequently, transition to neck dissection on the left side. Here, the vascular nerve sheath of the sternocleidomastoid muscle is exposed after a skin incision and sharp transection of the platysma. Regions I-V are then removed while preserving all non-lymphatic structures. Macroscopically, cervical metastasis is often suspected. The carotid bifurcation is then completely exposed and the internal carotid artery is followed cranially to the radiologically visible metastasis on the atlas arch. After cutting the digastric muscle, also cut the stylohyoid muscle and expose the entire length of the styloid process. The metastasis is exposed craniomedially, which is successively dissected free and finally removed with complete skeletonization of the internal carotid artery up to its entry into the base of the skull. Subsequent transition to neck dissection on the right side. Here a metastasis is seen in region IIb, which has infiltrated the vein as well as the muscle and nerve. The internal jugular vein is removed caudally and the specimen is removed together with the sternocleidomastoid muscle, dissecting the accessorius nerve up to the digastric muscle. The internal jugular vein is then also ligated at the base of the skull and finally removed. The hypoglossal nerve and vagus nerve can of course be preserved. Insertion of a Redon suction drain and two-layer wound closure on the right side. Subsequent transition to the opposite side and creation of an opening in the hypopharynx in the area of the submandibular lobe after skeletonization of the hypoglossal nerve. Elevation of the radial lobe graft through <CLINICIAN_NAME> and <CLINICIAN_NAME>. Marking of the radial artery, palpatory identification of the distal radial artery and the ulnar artery. Marking of the flap borders (7 x 3 cm) on the distal forearm proximal to the flexor retinaculum with an S-shaped incision extending proximally into the cubital fossa. Incision of cutaneous and subcutaneous tissue from the proximal side. 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 graft margin. Identification of the external ramus, the superficial ramus, the radial nerve, protection of these. Exposure of the vascular pedicle between the flexor carpi radialis muscle and brachioradialis muscle, here dissection of the pedicle without damaging the vessel to be anastomosed. The incision is now made along the flap borders on the distal forearm. Elevation of the radial portion while leaving the fascia of the brachioradialis tendon intact. Subsequent dissection down to the forearm fascia. Incision of the fascia and subsequent subfascial elevation of the forearm fascia of the graft edge up to the tendon of the flexor carpi radialis muscle. Care is taken to leave the peritendinous tissue on the flexor tendon and to protect the ulnar artery. Identification of the artery. Clamp the radial artery with a vascular clamp. After 5 minutes under good pulsoxymetric oxygen saturation measured on the thumb (approx. 98 %), the vessels are removed with subsequent ligation with silk thread after the flap umbrella has already been completely detached from the base. Perforators were treated with a vessel clip. Bipolar coagulation. The radial nerve in the median side of the brachioradialis muscle remains intact. The brachial artery was exposed as well as the recurrent radial artery, ulnar artery, radial artery and interosseous artery; the radial artery was removed while sparing all of the above vessels and ligated using a silk thread. Subtle hemostasis in the area of the wound bed using bipolar coagulation forceps. Two-layer wound closure in the area of the proximal forearm and defect coverage of the graft with split skin from the right thigh in a typical manner with stitching of the split skin. Application of a wound dressing, forearm splint, completion of graft elevation without complications. Subsequent insertion of the radial artery flap graft into the defect and suturing to the soft palate and the base of the tongue combined transorally and transcervically. After removal of the facial artery at the lower jaw, the arterial anastomosis is performed with the radial artery. The venous anastomosis is formed by 2 arm veins in a Wend-to-side manner to the internal jugular vein. Finally, insertion of a Redon suction drain and a drainage flap, multi-layer wound closure. Re-intubation of the patient onto an 8-gauge tracheostomy tube. Sterile wound dressing and end of the operation. Transfer of the patient to anesthesia. Conclusion: Resection of an oropharyngeal carcinoma on the left side with primary reconstruction using a free-stemmed radial flap from the left forearm with primary coverage of the defect on the left forearm with split skin from the right thigh. On the left side, selective neck dissection of regions I to V with removal of a metastasis in front of the atlas arch. On the right side, radical neck dissection with infiltration of the internal jugular vein, the accessorius nerve and the sternocleidomastoid muscle.  