<CLINICIAN_NAME>: Induction of anesthesia and intubation by the anesthesiologist, then first of all, insertion of the small bore tube and examination of the tumor. It can be seen that the tumor already starts at the lower tonsil pole on the right side and extends along the hypopharyngeal side wall and posterior wall into the piriform sinus, filling it completely and infiltrating the larynx laterally. Then sterile washing and draping and creation of an apron flap in the usual manner. Start with the neck dissection on the right side. Exposure of the sternocleidomastoid muscle. Exposure of the omohyoid muscle and the submandibular gland. Then locate the accessorius nerve and clear levels II b, III, IV and V while sparing the plexus branches. Exposure of the hypoglossal nerve and evacuation of the medial upper neck preparation. Then evacuation of the neck level VI and separate insertion of the neck level VI. Then turn to the opposite side and perform the neck dissection on the left side in the same way. Several large, coarse metastases are visible on the right side. On the left side only unspecifically enlarged lymph nodes. Then detachment of the cervical vascular sheath from the tumor and from the larynx. Detachment of the tumor from the spinal column. This is achieved without any problems using blunt dissection. Perform a median pharyngotomy at the level of the epiglottis. Then grasp the epiglottis and pull the epiglottis through the pharyngotomy. Carefully incise the mucosa along the aryepiglottic fold, first on the left side, then on the right side, observing the tumor margins. Release the laryngeal preparation in the posterior part. Then perform the tracheotomy. Enter the trachea between the 1st and 2nd tracheal cartilage. The patient has had a history of thyroidectomy, so that no thyroid gland was present. Suturing of the lower skin to the trachea. Then placement of a feeding tube under visualization. Locate the esophagus and remove the laryngeal specimen and the tumor specimen. An approx. 3 cm wide strip of mucosa remains in the upper part of the pharynx, but this becomes significantly smaller in the lower area, so that primary closure of the pharynx does not appear possible and the decision is therefore made to sew in a radialis graft in any case. In the meantime, suture marks are placed on the tumor specimen and the entire specimen is guided to the frozen section. Unfortunately, resection is necessary in 2 places, once in the area of the epiglottis and then at the caudal edge of the deposit. This is done by taking a resection specimen, which goes to the final histology and then new frozen sections. Both new frozen sections are tumor-free, so that an R0 situation can be confirmed intraoperatively. Therefore, lifting of the radialis graft and insertion of the graft as well as anastomosis of the vessels by <CLINICIAN_NAME>. Parallel removal of the split skin from the right thigh and suturing of the split skin to the forearm. Application of a Mepilex dressing. Fixation of the Mepilex dressing with Mersilene sutures. Application of a Kramer splint. Completion of the operation without complications. <CLINICIAN_NAME>: Now removal of the forearm flap from the left forearm: After measuring the defect, the flap dimensions are 13 to 14 cm in length and at least 8 to 9 cm in width. Record the flap with a skin monitor on the left forearm. Then first cut around the flap ulnarly. Dissect the skin, leaving subcutaneous tissue in the area of the planned subcutaneous bridge to the skin monitor, which is cut around. Continue the incision into the crook of the elbow. The flap is lifted ulnarly subfascially while preserving the ulnar artery. Then, after locating the superficial venous system and including it in the flap pedicle, lift the flap subfascially from the radial side. Locate the vascular pedicle under the brachioradialis muscle and follow it to the elbow. Locate the radial artery caudally and clamp. First lift the flap from the radial subfascial. Subsequently, the radial artery is removed. This is treated distally and proximally with 4-0 Prolene sutures. Lift the flap subfascially along the flap pedicle, taking the subcutaneous tissue with it to the skin monitor. Individual vessels are bipolarly coagulated or clipped. In the antecubital region, visualization of the radial artery of the confluence with the brachial artery and the outlet of the interosseous artery. Subsequent exposure of the cephalic vein, which splits into 2 vein ends, with connection to the deep vein system. The radial artery splits into smaller veins in the area of the confluence, which is not suitable for anastomosis and is separated and supplied with a clip. Another caudal vein, which arises from the subcutaneous tissue of the skin monitor, can initially be retained. The flap is removed. Veins are ligated. The artery is treated with 6-0 Vascufil sutures. Flush the flap with heparin solution. Subsequent insertion of the flap: First myotomy laterally to facilitate passage of food later. Subsequent suturing of the flap successively with Vicryl 3-0 single button sutures to the remaining mucosal bridge in the case of a subtotal pharyngeal defect. Defect extends to the palatal arch in the area of the uvula. Flap suturing is successful at all points without tension. Partial duplication of the suture to secure it. Subsequent conditioning of the vessels. The radial artery is anastomosed with the lingual artery using 8-0 single Ethilon button sutures. After opening the clamp, good arterial flow and good venous return. An outlet of the cephalic vein is then conditioned and anastomosed with the facial vein using a 3.0 coupler. Here too, after opening the clamp, good venous flow. Positive smear phenomenon. The other end is anastomosed with the external jugular vein using a 2.5 mm coupler; here too, good flow conditions after opening the clamp. Positive smear phenomenon. Then careful hemostasis. Irrigation of the entire wound area. Repositioning of the apron flap. Suture the apron flap to the trachea without tension. The skin monitor is integrated into the skin on the right side with a right-sided vascular connection. Redon drains were inserted on both sides, guided on the right. Finally, insertion of a size 10 tracheal cannula, which is fixed with sutures. The site for Doppler control is marked on the right side in the area of the external jugular vein. The procedure is completed without complications. Patient goes to the intensive care unit for postoperative monitoring. Please continue antibiotics for 2 to 3 days, which were started intraoperatively with clindamycin. Feeding via the PEG tube for at least 10 days, then gruel and, if necessary, diet build-up. Provox was not applied intraoperatively due to the flap situation and can still be applied at intervals. Please check the flap via skin monitor and Doppler sonography according to the scheme. Continue heparin perfusor 500 units per hour for 5 days. Overall cT4a cN2/4b oropharyngeal/hypopharyngeal/laryngeal carcinoma on the right. Postoperative radiochemotherapy should certainly be discussed.