Induction of anesthesia by the anesthesia colleagues. Start with the tracheotomy, after injection, covering and abjodation. Vertical incision from the cricoid cartilage to about 2 cm above the jugulum. Spread the infrahyoid muscles apart. Locating the thyroid isthmus and intermittent ligation of larger veins. Detachment of the thyroid isthmus from the anterior surface of the trachea. Coagulation and transection. Insertion between the second and third tracheal cartilages. Epithelialization of the tracheostoma and reintubation onto an LE tube. Followed by oesophagogastroscopy with problem-free endoscopy up to the stomach and, with good diaphanoscopy, problem-free insertion of a PEG tube using the thread pull-through method in the typical manner. Combined transoral transcervical surgery including left neck dissection now follows: First, positioning of the tumor using a Mc Ivor spatula or mouth retractor. Cut around the tumor with a safety margin of 1-1.5 cm on all cranial sides. The anterior palatal arch and parts of the posterior palatal arch are removed. Resection extends over the alveolar ridge to the lower jaw. Here the tumor is pushed away from the lower jaw, bone is not infiltrated. Neck dissection on the left is then necessary before continuing with the transcervical resection. Typical skin incision. Exposure of sternocleidomastoid muscle, exposure of omohyoid muscle and digastric muscle. Exposure of the internal jugular vein, facial vein, internal carotid artery, external carotid artery. Depiction of the lingual artery, facial artery and superior thyroid artery. Exposure of the hypgoglossal nerve and 'N. accessorius. Level II-V are removed, also taking into account and preserving the branches of the cervical plexus, several cranial lymph node metastases, which are easy to remove. Level II-III lymph node metastases. Subsequent continuation of the tumor resection. Dissection of the digastric muscle. Subsequent removal of the submandibular gland with preservation of the oral branch. Exposure and preservation of the hypoglossal nerve. Snaring of the hypoglossus and snaring of the large vessels using vessel loops. Dissection of the large vessels from the pharyngeal tube. Subsequent dissection from the inside through the pharyngeal tube to the outside under external and internal control. The tumour is gradually mobilized further. Due to the spread of the tumor to the alveolar ridge or lower jaw. The periosteum is pushed off along this line. The inferior alveolar nerve is now seen to be integrated into the tumor and is or must be resected. Resection up to the front of the floor of the mouth with parts of the posterior floor of the mouth. A small part of the base of the tongue is resected. Pharyngeal wall is resected en bloc. Lateral parts of the hyoid bone and the external musculature here are also resected. The hypoglossal nerve can be preserved. The tumor specimen is then removed. This is thread-marked. Additional marginal sample from the soft tissue cranial basal from the area of the pterygoid muscle. Marginal sample from the alveolar ridge in the entire area of the exposed bone at the border to the mucosa of the alveolar ridge. In the frozen section, the preparation and marginal samples are free. Extensive irrigation of the wound area with H202 and Ringer's solution. Hemostasis. Repositioning of the patient for neck dissection. Injection of a total of 12 ml of local anesthetic with adrenaline in the area of the planned incision. Start on the right side. Skin incision extended medially to the front. Subcutaneous preparation. Separation of the platysma. Exposure of the sternocleidomastoid muscle and dissection of its medial side. Visualization and exposure of the accessorius nerve. Exposure of the omohyoid muscle and free dissection of the same up to the hyoid bone. Then exposure of the lower surface of the submandibular gland and elevation of the lateral connective tissue mantle. Exposure of the digastric muscle. Connection of the boundaries now created. Exposure of the vascular nerve sheath and detachment of the lateral neck preparation. Separation of the same. Gradual dissection of the medial neck preparation. Protection of the hypoglossal nerve. Protection of the external jugular vein. Especially in level II on the right side, there are some relatively large, rough and darkly discolored nodules, thus a suspected cN2c neck status. Minutious hemostasis. Redon system. Subcutaneous suture and skin suture. Parallel lifting of the radialis graft <CLINICIAN_NAME>. Elevation of the radial forearm flap on the left by <CLINICIAN_NAME>: Palpatory identification of the distal radial artery. Marking of the flap boundaries (size) 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. Defect coverage 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. Then removal of the radialis graft and suturing of the radialis graft, this is done by placing sutures transcervically and also transorally. Finally, an anastomosis is made between the radial artery and facial artery and facial vein and an outlet from the facial vein. This is successful without any problems. The patient goes to the intensive care unit ventilated. Please check the flap in the usual way.