First, laryngoscopy and pharyngoscopy again: confirmation of tumor spread and the probability of flap coverage. Subsequent PEG insertion: insertion of the esophagoscope. After creation of the diaphanoscopy, insertion of a 15 mm abdominal wall probe without complications. Fixation to the abdominal wall in the typical manner. Then repositioning for transoral tumor resection: insertion of the retractors and insertion of the tongue bridle suture. Successive removal of the tumor with a safety margin of at least 1.5 cm on all sides, also in the area of the soft tissue of the tongue. This results in a complete hemiglossectomy except for the anterior tip of the tongue, which crosses the midline in the posterior region and extends down to the base of the tongue. The glossoalveolar groove and the beginning of the tonsil lobe are also resected. The lingual nerve is partially preserved, as is the wharton duct. Tumor is completely removed macroscopically in the healthy tissue. Tumor is thread-marked. The uncinate process is removed basally as a marginal sample, as are parts of the mylohyoid muscle and external tongue muscles as basal marginal samples in the front. In addition, an extensive marginal sample of the floor of the mouth/base of tongue muscles from the area of the glossotonsillar groove to the base of the tongue. The latter two marginal samples, as well as the entire preparation, are thread-marked for frozen section. In the frozen section, the specimen and all marginal specimens are removed in healthy tissue, thus R0 resection. Measure the size of the flap, which is 12 x 6-7 cm. Careful hemostasis. Subsequent repositioning for continuation of the operation. Skin disinfection and sterile draping of all necessary surgical areas including the left forearm and right thigh. Neck dissection on the right is performed by <CLINICIAN_NAME>: Skin incision in typical manner, exposure of sternocleidomastoid muscle anterior border, dissection of fat lymph node preparation. Exposure of the internal jugular vein, external jugular vein, facial vein. Exposure of internal carotid artery, external carotid artery, exposure of vagus nerve, accessorius nerve and hypoglossal nerve. All structures are preserved. Removal of the fat lymph node preparation from levels II to IV as well as Va and b below the branches of the cervical plexus. Neck dissection on the left side is then performed by <CLINICIAN_NAME> and is carried out in the same way as on the right side with removal of levels II to V. Then tracheostoma creation: this is performed by <CLINICIAN_NAME>. Small Kocher collar incision. Exposure of infrahyoid muscles, division of these. Exposure of the thyroid isthmus, which is undercut, clamped, severed and supplied by puncture ligation. Exposure of the trachea. Entering the trachea in the 2nd/3rd intercartilaginous space. Creation of a wide pedicled modified Björk flap. Epithelialization of this. Re-intubation and insertion of an 8 mm Woodbridge tube. Then radialis flap harvesting: marking of the flap size, this is 12 x 7 cm. The flap is first lifted subfacially from the ulnar side. The incision is then extended to the elbow. Then expose the superficial venous system and lift it subfascially. Then expose the connection to the deep venous system. The flap is then lifted off radially. This is done subfascially. Exposure of the lateral antebrachial cutaneous nerve. This is preserved. Distal exposure of the radial vein and artery, which is first clamped. After sufficient clamping time with always sufficiently high saturation of 95 to 100 %, the radial artery is removed. Successive lifting of the flap with the pedicle subfascially. Smaller vessels are clipped or bipolar coagulated. Exposure of the entry of the radial artery into the brachial artery in the antecubital fossa. After clamping and a certain necessary waiting time, the interosseous artery is supplied with clips and cut. A large venous outlet from the cephalic vein can be visualized in the antecubital fossa. The confluence can also be visualized, although it is very small. Finally, the radial artery is first removed at the brachial artery. Treatment with 6-0 Vascufil sutures over and under. Hand perfusion then remains stable. Removal of the veins. These are ligated proximally in the stumps. The flap pedicle is then flushed with heparin via the veins and artery. The flap is now inserted enorally into the defect. The stalk is passed through a tunnel into the neck parts; the submandibular gland is resected first. The Wharton's duct is cut off. The lingual nerve is preserved as far as possible. A sufficiently wide tunnel is now created. The stalk is inserted into the soft tissues of the neck on the right. The flap is initially sutured into the defect with 3-0 Vicryl single button sutures, partly by advancing the flap and preserving the continuous pedicle. The defect can be covered completely and without tension. The vessels are then conditioned. After conditioning, the radial artery is anastomosed with the superior thyroid artery using 9-0 Ethilon single-button sutures. After opening the clamps, good arterial flow and good venous return. The two outlets of the superficial venous system are then conditioned. The external jugular artery is removed, ligated proximally and supplied distally with a clamp, flushed with heparin and conditioned. The V. thyroidea media is also removed and rinsed with heparin and conditioned after clamping and removal with ligation. The anastomosis between the larger outlet of the superficial venous system and the external jugular vein is performed using a 3-0 coupler. After opening the clamp, good venous return, positive smear phenomenon. Subsequent anastomosis between the smaller outlet of the cephalic vein and the V. thyroidea media with a 2.5 mm coupler. This was also without complications, positive smear phenomenon, good venous return. The flap pedicle is then inserted into the soft tissues of the neck and sutured slightly medio-cranially to prevent tortuosity. The sides of the neck are completely irrigated and extensive hemostasis is performed. The wound was closed in layers by inserting a Redon drain on the left and 2 Penrose drains on the right, which were fixed with sutures and the tracheostoma was epithelized. In the forearm area, the wound is closed proximally in layers. The skin is then closed using split skin. This is first removed from the right thigh in a sufficient size of approx. 13 x 7 cm. A hydrocolloid dressing is applied to the thigh. The split skin is gradually worked into the defect, creating a complete tension-free wound closure. Octenidin gel is applied to the split skin and Mepilex is applied on top. Loose compresses are applied to the Mepilex. The forearm is then wrapped in absorbent cotton. Fitting of a Cramer splint. Fixation with a tape bandage in the functional position of the hand. Hand always sufficiently and well supplied with blood until the end. Attachment of the arm. Checking the flap enorally. This is well supplied with blood. Woodbridge tube is replaced between 8 mm tracheal cannula which is fixed with sutures. The sites of the vascular anastomoses are marked on the skin using sutures. The procedure is completed without complications. Patient goes to the intensive care unit for postoperative monitoring. Please continue the antibiotic treatment, which was started intraoperatively with Unacid, for one week postoperatively. Feeding via the PEG tube for 7-10 days, then dietary support according to flap status. If necessary, X-ray paps. Heparin perfusor, which was started intraoperatively at 500 E/h, should be continued postoperatively for 5 days. Flap control according to the scheme clinically by enoral inspection or also by checking the Doppler probe. Overall cT2-3 tongue margin carcinoma also tending towards cT4 due to infiltration of the external tongue muscles and the floor of the mouth. Waiting for the postoperative histology and presentation at the interdisciplinary tumor conference regarding adjuvant therapy.