Induction of anesthesia and intubation transnasally by the anesthesia colleagues. Then sterile washing and draping. Then inspection of the oral cavity and oropharynx. There is an exophytic mass in the area of the soft palate, starting on the left side, which extends over the entire soft palate on the left and 2/3 of the soft palate on the right, including the uvula. The carcinoma spreads to the alveolar ridge and moves towards the glossotonsillar groove and infiltrates a small part of the base of the tongue. Now start with the tumor inspection: First use the monopolar needle to cut around the carcinoma in the soft palate area at a distance of 1-1.5 cm. Careful dissection with removal of the entire soft palate on the left side and 2/3 of the soft palate on the right side. Then resection of the gum from the alveolar ridge of the lower jaw on the left. Here the mass can be easily pushed away from the bone and removal of the posterior palatal arch, mostly on the left side. Removal of the glossotonsillar groove and part of the base of the tongue. Then send the entire preparation for frozen section. In the area of the base of the uvula to the border of the soft palate on the right and in the wound bed in the area of the pterygoid process and in the area of the glossotonsillar groove, carcinoma in situ can still be detected in the frozen section. These areas are resected everywhere and another frozen section is made. Then finally R0. A frozen section can no longer be obtained in the area of the pterygoid process, as this has been resected down to the bone. The pterygoid process is then chiseled off in this area and sent as a marginal sample for final histology. Now measure the defect. The defect is 14 cm from cranial to caudal, including the width of the soft palate. Now transition to neck dissection on the left side. Here, skin incision 2 ˝ QF below the mandible and exposure of the sternocleidomastoid muscle, the omohyoid muscle and the submandibular gland, the cervical vascular sheath, the vagus nerve and the accessory nerve. Free preparation of the internal jugular vein. After previous neck dissection there is hardly any fatty tissue and no visible lymph nodes. Sonography revealed conspicuous lymph nodes in level Ib. The submandibular gland is removed here. The digastric muscle is severed. This automatically leads to the oral cavity area. Clearing of level Ia and b and here several enlarged and also suspicious appearing lymph nodes are found, all of which are also removed. Then neck dissection of the right side by <CLINICIAN_NAME>. The skin of the neck is massively scarred due to previous surgery. Horizontally curved skin incision in a skin fold along the former scar. Dissection of the subcutaneous fatty tissue. Exposure of the anterior margin of the sternocleidomastoid. Difficult preparation conditions with scarred conditions in the case of previous surgery. Exposure of the omohyoid muscle. Exposure of the submandibular gland, the accessorius nerve and the cervical vascular sheath. Here too, difficult preparation conditions in the case of previous surgery and scarred, caked conditions. The jugular vein and vagus nerve are scarred with the sternocleidomastoid, but can be detached and spared. The carotid artery can be visualized in depth. In the area of the jugular vein, there is an injury to the same. This is grasped with the Satinsky clamp and sutured over with Vascufil. No further bleeding here. If there is a history of neck dissection on this side, no actual neck preparation can be developed here as no lymphatic tissue can be visualized. Demonstration of findings on <CLINICIAN_NAME> and <CLINICIAN_NAME>. Some tissue is removed from the caudal part above the omohyoid muscle and sent for histology. Punctual hemostasis using bipolar coagulation. Irrigation of the wound with hydrogen and Ringer's and, if the blood is dry, insertion of a Redon drainage and two-layer wound closure. The radial artery graft is lifted at the same time. Palpation of the radial and ulnar arteries. Marking of the defect, taking into account the duplication on the soft palate. Applying the tourniquets and cutting around the graft. Visualization of the cephalic and basilic veins and the venous star in the crook of the elbow. Exposure of the brachioradialis muscle, the nerve and the superficial ramus of the radial nerve. Unfortunately, one branch cannot be spared as it lies too far below the graft and the size of the graft is so large that the nerve branch cannot be dissected out. This branch must therefore also be removed. Exposure of the radial artery with the accompanying vessels and ligation and transection of these. Lift the graft from the tendon bed and dissect the pedicle up to the crook of the elbow. Lifting the venous confluence and one superficial and one deep vein. Then suture the arm in the usual way. Lifting of split skin from the right thigh to cover the defect on the left forearm and application of a pressure bandage with sewn-on swabs and application of a dorsal forearm splint. In the meantime, the graft is sutured into place. This is very difficult as the mouth opening is severely restricted and can only be opened slightly even under maximum relaxation. The graft is first fixed in the area of the nasopharynx, then folded and sutured in the area of the soft palate. Then further down to the oropharynx area. This is very difficult and has to be done partly transcervically due to the small mouth opening. The graft is finally sutured in completely. Then turn to the vessels of the neck. This is where the superior thyroid artery is located, which is conditioned as a connecting vessel. Only the facial vein is still present as a venous connection vessel. A branch located higher up can no longer be used because the caliber is too small, so the arterial anastomosis is performed as usual and only the facial vein is used as the venous anastomosis without connecting a second accompanying vein. Ultimately, good pedicle pulsation and no venous congestion in the graft. Insertion of a flap and two-layer wound closure. Before insertion of the flap, the tracheotomy is performed in the usual manner and inserted between the 2nd and 3rd tracheal cartilage. A visor tracheotomy and a mucocutaneous anastomosis are performed and at the end of the operation the patient is intubated with a 9-gauge tracheostomy tube. The patient is ventilated and admitted to the intensive care unit. He should continue to receive antibiotics for 24 hours. On the 10th day, please perform an X-ray emesis and build up a diet. Presentation of the patient in the tumor conference after receipt of the histology.