Induction of anesthesia and intubation by the anesthesia colleagues, then first performing the tracheotomy by <CLINICIAN_NAME> and <CLINICIAN_NAME>: 2 cm horizontal skin incision just below the cricoid cartilage, 2 QF above the jugulum and cutting through the cutaneous-subcutaneous tissue. Ligation of superficial veins, division of the musculature in the vertical line and pushing the musculature to the side. Pointed dissection of the cricoid cartilage. Identification of the thyroid isthmus. Blunt undermining of the thyroid isthmus and ligation of the same. Freeing the trachea. Identification of the 2nd and 3rd tracheal rings. Insertion between the 2nd and 3rd tracheal ring and creation of a visceral tracheotomy in the usual manner. Suturing of the tracheal cartilage to the skin to create an epithelialized tracheostoma. This is done without complications. Placement of an 8 mm tracheal cannula. Then repositioning of the patient and sterile washing and draping. Insertion of the Mc Ivor mouth blocker and inspection of the site. A rather flat, exophytic mass was found in the area of the posterior palatal arch and the posterior pharyngeal wall as well as partially in the tonsil on the right side. Start of tumor resection with the monopolar needle. It soon becomes apparent that the tumor has deeper parts. Then dissection in depth. Here, massive venous bleeding suddenly occurs. This can no longer be controlled by transoral measures. Therefore, the oropharynx is tamponaded and the neck is opened on the right side. Exposure of the cervical vascular sheath. Identification of the external carotid artery. Then temporary clamping of the external carotid artery with a reinforced bulldog, nevertheless further bleeding, then further dissection of the cervical vascular sheath. Here it can be seen that a large outlet from the internal jugular vein has opened very high up and is bleeding gushingly into the oropharynx. This outlet is carefully clamped and clipped several times. Immediate hemostasis and now further dissection of the neck and performance of the remaining tumor resection from the transcervical side. The specimen is placed on cork and sent directly to the frozen section. In the frozen section, all edges are free of tumor and carcinoma in situ until medium-grade dysplasia in the cranial area, which is then resected again later and the specimen sent for final histology. Then further surgery in the neck on the right side and start with the neck dissection. Exposure of the sternocleidomastoid muscle, exposure of the omohyoid of the submandibular gland and the digastric muscle. Then removal of the neck specimens IIa to Va while sparing the plexus branches and sparing the hypoglossal nerve and accessorius nerve. Dissection of the neck vessels. It can be seen that there are only very slender vessels here, both venous and arterial, and that this side is also not suitable for connecting the radialis graft. On the left side, neck dissection through <CLINICIAN_NAME> and <CLINICIAN_NAME>, exposing the sternocleidomastoid muscle, exposing the submandibular gland, the omohyoid and the digastric muscle. Then expose the cervical vascular sheath, the hypoglossus and the accessorius nerve and remove the neck preparation IIa to Va while sparing the plexus branches. Dissection of the vessels. This also shows a very, very thin superior thyroid artery and the facial artery is also unsuitable for connection of an anastomosis; the venous situation is significantly better than on the right side. There is a very thick facial artery with an outlet, which is perfectly possible for venous connection. For the arterial connection, the external carotid artery itself is prepared in the cranial region above the exit of the superior facial and lingual thyroid arteries and also above the ascending pharyngeal artery, then cut downwards. In the meantime, the radial artery graft is lifted in bloodlessness by <CLINICIAN_NAME> and <CLINICIAN_NAME>: Palpatory identification of the distal radial artery. Marking of the flap borders (7 x 9 cm) 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. At the beginning of the operation, a PEG was placed with good diaphanoscopy using the thread pull-through method. Continue antibiotics. The patient can wake up postoperatively, but should continue to be monitored in the intensive care unit. Block attempt without an X-ray pre-swallow on the 10th postoperative day.