Dictation <CLINICIAN_NAME>. Induction of anesthesia and intubation by anesthesia colleagues. Sterile washing and draping. Start of tracheotomy: vertical skin incision for this. Dissection through the subcutaneous fatty tissue. Exposure of the linea alba. Push the muscles to the side. Exposure of the thyroid isthmus. Undermining of the thyroid isthmus and coagulation and transection of the thyroid isthmus. Exposure of the anterior tracheal wall and entry into the trachea between the 1st and 2nd tracheal cartilage. Creation of a visor tracheotomy. Creation of a mucocutaneous anastomosis. Repositioning of the patient, sterile washing and draping. Insertion of the mouth blocker. Inspection of the tumor. The tumor covers the entire soft palate median and paramedian on the right. The tumor is incised with the monopolar needle with a safety margin of 1 - 1.5 cm. Detachment of the tumor from the soft palate and from the anterior and posterior palatal arch, which must be partially resected on both sides. Measure the defect: 7.5 x 6 cm. Parallel neck dissection on both sides and lifting of the radialis graft. Neck dissection on the right side. Skin incision in the usual manner on the anterior border of the sternocleidomastoid muscle. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle. Exposure of the submandibular gland. Exposure of the cervical vascular sheath and detachment of the neck preparation II a to V a while preserving the plexus branches. Exposure of the vessels. Exposure of the superior thyroid artery, external artery and external jugular vein and facial vein, which will also be used later for the connection. Neck dissection on the left side. Skin incision also on the front edge of the sternocleidomastoid muscle. Exposure of the sternocleidomastoid muscle, the submandibular gland, the omohyoid muscle and the digastric muscle. Exposure of the cervical vascular sheath and release of the neck preparation II a to V a while sparing the plexus branches. Insertion of a Redon drain and two-layer wound closure. On the left side, the submandibular gland is removed and the digastric muscle is cut to create a breakthrough to the enoral side, where the stalk can later be removed. Sending the tumor to pathology. The frozen section revealed carcinoma in situ on the left side at the anterior edge of the soft palate and at the posterior edge. A large resection was taken at both sites and another margin sample was taken. The final margin samples were free of tumor and carcinoma in situ. Radialis graft elevation <CLINICIAN_NAME>: Elevation of the radialis graft on the distal left forearm. Drawing of a radialis graft on the distal forearm with a size of 8 x 6 cm. Extending S-shaped skin incision to the proximal forearm in the crook of the elbow to the proximal forearm in the crook of the elbow. Separation of the cutaneous and subcutaneous tissue. Dissection of the deep forearm fascia. Identification of the confluence of the superficial and deep venous system. Identification of the cephalic vein. Ulnar skin incision in the area of the radialis graft and subfascial dissection up to the anterior edge of the flexor carpi radialis muscle. Radial skin preparation on the deep forearm fascia. Identification of the radial nerve (external ramus). Sharp dissection of the subfascial nerve. Particular care is taken to leave sufficient tissue on the tendon of the brachioradialis muscle. Identification of the distal part of the radial artery. Provisional clamping with a vascular clamp. Wait 10 minutes, during which time a good perfusion signal is recorded in the area of the index finger. Separation of the distal radial artery with the comitant veins and ligation. Elevation of the radial artery graft from the depths with constant bipolar coagulation of smaller vessels and placement of several vascular clips. This was successful without any problems. Completion of flap elevation without complications. Deposition of the flap by <CLINICIAN_NAME>. Wound closure using split skin from the right thigh in the usual manner by <CLINICIAN_NAME> and <CLINICIAN_NAME>. Incision of the graft: First, the back surface of the soft palate is fixed with three sutures. Folding and folding of the graft and suturing of the front and the tonsil region. The tonsil region is difficult to suture due to swelling of the tongue and small mouth opening. Ultimately, the flap can be sutured in completely and the stalk can be diverted to the right. Start with the anastomosis. The radial artery is connected to the superior thyroid artery. However, a problem then arises in that there is no venous return flow from the dissected veins. It is determined that the confluence between the upper and deeper venous system is insufficient in this radial artery graft. The entire upper venous system is therefore clamped off and the concomitant vein is used for connection. This shows very good reflux in both concomitant veins. Therefore, one is anastomosed end-to-side to the external vein and the second end-to-end to a branch of the facial vein using the coupler. Insertion of a flap and two-layer wound closure. The patient is ventilated and admitted to the intensive care unit. Please continue antibiotics for at least 24 hours. Flap and wound checks. At the end, a tracheostomy tube was inserted and fixed with a suture. Cannula change on the 5th postoperative day and then suturing again, as the vein situation is very critical and a cannula tape must not be passed over the neck for 10 days under any circumstances.