Induction of anesthesia and positioning of the patient. Entry with the small bore tube and inspection of the tumor. A flat, exophytic mass is seen on the right side, which starts on the pharyngeal side wall approx. 1 cm below the tonsil lobe on the right side and grows caudally. The mass ends at the entrance of the piriform sinus. The tip of the piriform sinus is free. The tumor infiltrates the mucosa at the arytenoid cartilage. However, the arytenoid cartilage itself is still mobile and does not appear to be deeply infiltrated. Infiltration of the thyroid cartilage cannot be ruled out. Intraoperative demonstration of the findings on <CLINICIAN_NAME> and <CLINICIAN_NAME>. It is decided to open the pharynx from the outside and perform the tumor resection from the cervical right side. First perform the neck dissection on the right side. To do this, expose the sternocleidomastoid muscle, the omohyoid muscle, the submandibular gland and the cervical vascular sheath. Free preparation of the internal jugular vein and clearing of neck levels II a to V a while sparing the plexus branches and the accessorius and hypoglossal nerves. Now dissect the thyroid gland from the hypopharyngeal and laryngeal area and enter the pharynx through <CLINICIAN_NAME>. The tumor can be easily visualized and is successively incised. The tumor itself can be retrieved en bloc. It is clear from the tumor resection that there is limited thyroid cartilage infiltration. In this case, thyroid cartilage is also resected and sent to histology attached to the tumor specimen. Now take edge samples. All mucosal margins are removed, including in the area of the arytenoid cartilage and soft tissue. All marginal samples are classified as R0 in the frozen section. The defect is so large that it cannot be closed primarily. A platysma flap was originally planned to cover the defect; this was also prepared in the caudal region and on the posterior surface as part of the skin incision. Ultimately, it became apparent that the patient's upper skin was extremely thin and there was virtually no subcutaneous layer, which meant that the platysma flap was not possible to cover the defect, as it could not be guaranteed that the remaining skin would remain vital. It was therefore decided to cover the defect with an anterolateral thigh graft. Turning to the leg. First Doppler the perforator vessels. 1 main perforator and 2 secondary perforators can be detected. The graft is drawn in so that the main perforator is positioned exactly in the center of the graft. Now incise along the anterior edge down to the rectus femoris muscle. Then dissect laterally into the sulcus between the rectus femoris and vastus lateralis muscles. The descending ramus can be localized here and followed cranially to the profunda femoris artery. From the descending ramus, the main perforator is localized using the Doppler and carefully dissected towards the graft so that it is completely preserved. The graft can now be cut around completely and the pedicle vessel can be placed at the bottom. A very good graft perforation can be seen over the main perforator the whole time. The 2 secondary perforators do not extend directly into the skin, but rather deep into the muscle, which is why they cannot be integrated into the graft. At the end, dissection of the pedicle and removal of the pedicle far proximally. Primary wound closure in several layers in the area of the remaining leg wound. The graft is sutured into place. Suturing must be carried out using pre-positioned sutures and is somewhat difficult, especially in the area of the base of the tongue. Finally, the anastomosis is performed. The arterial vessel is sutured to the superior thyroid artery, which must be very well prepared for this, as it is much smaller in caliber than the flap vessel. Nevertheless, an anastomosis can be created. The vein is connected to an outlet from the internal jugular vein using a coupler. Then graft control. There is good blood flow. Insertion of a Redon drain on the left side and a flap on the right side. Even before the neck is completely sutured shut, venous congestion is seen in the flap vessel, so the inserted coupler has to be opened again and it becomes apparent that the coupler was directly in front of a venous valve. The vein in the flap pedicle is therefore prepared and shortened again and recoupled to another vein. Now permanent, good return flow, therefore two-layer wound closure on the neck and insertion of a tracheal cannula after a tracheotomy was performed in the usual manner. Please check the flap according to the usual procedure. Continue antibiotics for at least 24 hours. Feeding via the PEG tube. The inserted nasogastric tube should be left in place as a splint for 10 days. If there is any indication of a fistula, please open the neck.