Induction of anesthesia and intubation by the anesthesia colleagues. Then determination of the external tumor morphology using narrow-band imaging and contact endoscope. Targeted biopsies are taken to verify the narrow-band imaging images and the biopsies are sent for final histology. Then start with tumor resection with a safety margin of at least 1-1.5 cm in the area of the tongue. The carcinoma has extensions within the tongue that go beyond the midline in the area of the tip of the tongue and also extend to the underside of the tongue. The tumor is removed en bloc. Then take marginal samples directly from the specimen. The marginal samples are all tumor-free. Then perform the neck dissection on the left side. To do this, make a skin incision in a transverse skin fold. Separation of the platysma. Dissection of the platysma cranially. Exposure of the sternocleidomatoid muscle. Exposure of the omohyoid muscle and the submandibular gland, the digastric muscle, the internal jugular vein and the facial vein as well as the external carotid artery, the facial artery and the superior thyroid artery. Clearing of neck levels IIa to Va while sparing the hypoglossal nerve, accessory nerve and plexus branches. The superior thyroid artery has an extremely small lumen. This is not suitable for a later graft connection. The facial artery and the facial vein are more suitable for this. Then work in parallel and perform the neck dissection on the right side through <CLINICIAN_NAME> and <CLINICIAN_NAME>. Dictation: <CLINICIAN_NAME>. Skin incision and dissection through the subcutaneous fatty tissue. Locate the external jugular vein. This is ligated. Further dissection through the platysma and subplatysmal. Bluntly spread subplatysmal with the pedicle. Now locate the anterior border of the sternocleidomastoid muscle and dissect the anterior border caudally. Anterior transection of the dermal fibers via region II b. Locate the accessorius nerve. Now expose the omohyoid muscle up to the hyoid. Locate the submandibular gland and approach the capsule sharply. Pull up the gland with the Langenbeck and locate the digaster muscle. Blunt dissection with the clamp anteriorly and posteriorly on the digaster. Clear the triangle between the omohyoid and digaster anteriorly and the sternocleidomastoid and digaster posteriorly. The accessorius nerve can be spared at any time without any problems. Now dissect the medial neck triangle along the cervical nerve. Release the medial neck preparation. Dissection of the internal jugular vein in its entirety. Locate the common carotid artery and the vagus nerve. When preparing the medial neck preparation, the superior thyroid vein is ligated. Now dissect the lateral neck preparation from cranial to caudal. The accessor nerve can also be spared here. The hypoglossal nerve is exposed and is also spared. Dissection in depth down to the cervical plexus. Levels II to IV are carefully dissected out. Hilus is not visible. The cervical sinus can be preserved. If there is no increased bleeding and the wound is free of irritation, hydrogen and ring irrigation, two-layer wound closure. Lifting of the radialis graft by <CLINICIAN_NAME> and PJ. Marking of the graft on the forearm, then unwrapping of the graft and setting of the tourniquet. The graft is 9 x 6 mm in size and is incised. Exposure of the brachioradialis muscle, exposure of the radial ramus superficialis nerve, which is divided into 2 branches. Exposure of the radial artery. Ligation and transection of the radial artery, then lifting of the graft from the tendons and dissection of the pedicle up to the antecubital fossa. There is good confluence between the superficial and deep venous system in the antecubital fossa. However, the cephalic vein could not be integrated into the graft as it is located too far laterally. Nevertheless, the part of the cephalic vein that lies proximal to the venous confluence is prepared for a connection and a further venous connection from the deep system. Deposition of the graft, then suturing of the graft in the tongue area. Reconstruction of the tip of the tongue by incising and suturing the graft to form a rounded tongue tip, which is adapted to the remaining tongue tip defect. During neck dissection, a tunnel was created to the tongue in the mouth area. The submandibular gland was removed and the digastric muscle was severed to create a passage 3 fingers wide. The stalk was guided outwards here. The radial artery was anastomosed to the facial artery and the veins to the facial vein and the second vein to a direct outlet from the internal jugular vein. A size 2.5 coupler was used for this. Finally, the tracheotomy was performed. For this, a skin incision was made below the cricoid cartilage. Dissection down to the musculature. Push the muscles aside. Enter the trachea between the 1st and 2nd tracheal cartilage and create a muco-cutaneous anastomosis. Re-intubation to an 8 mm tracheal cannula. If the flap is well perforated, the patient is ventilated and admitted to the intensive care unit. Please continue antibiotics for 24 hours. Nutrition for 10 days via the PEG tube, then if necessary, X-ray pre-swallow and cautious diet build-up.