After appropriate preparation, first insertion of the TE blocker. Now look at the palatal arch, which is completely affected by the tumor from one tonsil to the other; the uvula is only attached to a small connective tissue bridge infiltrated by the tumor and is resected. The tumor is then resected starting at the right caudal tonsil pole with the ultrasonic knife. This continues to the opposite side, in principle removing the entire soft palate. The resection ends again at the lower left tonsil pole. The preparation is then marked with sutures, particularly in the middle section. The main specimen is also examined using frozen section histology and proves to be a tumor resected in sano, also in the middle section. The subsequent marginal sections taken from the surrounding mucosal or defect margins also all proved to be tumor-free. After measuring the defect, a radial lobe graft of about 11 cm in length and up to 6 cm in width was required. Radialis flap left through <CLINICIAN_NAME>: Marking of the landmarks after sterile abjoration and covering. Skin incision and dissection through the subcutaneous fatty tissue. Locate the cephalic vein and dissect it distally. Finding the venous confluence in depth. Dissection of the 2 superficial veins into the antecubital fossa. Finding the pedicle between the bellies of the brachioradialis muscle and the flexor carpi radialis. The confluence is very small with a thickness of about 1 mm, but it can be preserved. Several other veins and connectors are also very small and delicate and can all be preserved. Exposure of the pedicle between the muscle bellies. Exposure of the radial artery at the junction between the brachial and ulnar arteries. Now mark the ulnar borders. The flap is lifted 12 x 6 or 3 cm wide. Ulnar incision and elevation of the myofascial flap up to the tendon of the flexor carpi radialis. Further incision and lifting of the graft with involvement of the cephalic vein. Protect the superficial ramus of the radial nerve. The ulnar artery on the opposite side can also be spared without any problems. Locate the radial artery distally and mark it with a silk thread. To prevent shearing, the fascia is sutured to the skin with 4-0 Vicryl. Now continue to successively dissect the flap, incorporating the pedicle. Lifting the flap and separating the vessels. Stitching over exposed tendons, removal of split skin. Suturing of split skin and two-layer wound closure in the usual manner. Creation of pie crusts and application of a sterile plaster cast. Neck dissection on the right by <CLINICIAN_NAME>: Incision of the skin on the anterior edge of the sternocleidomastoid muscle (2 transverse fingers below the mandible extending mediocaudally). Separation of the subcutaneous tissue and the platysma. Subplatysmal dissection anteriorly and posteriorly. Identification of the omohyoid muscle. Dissection along the muscle up to the level of the hyoid bone. Now also identify the anterior edge of the sternocleidomastoid muscle and dissect down to the deep cervical fascia. Care is taken to preserve the branches of the cervical plexus. Identification of the accessorius nerve and release of the nerve from the cranial neck preparation. The digastric muscle is exposed in depth. Dissection along the muscle up to the level of the hyoid bone. Now free the neck preparation from the cervical vascular nerve sheath while protecting the nervous and vascular structures. No abnormalities on dissection. Some slightly more prominent lymph nodes in region II. Now remove the neck specimen in the usual way from cranial to caudal while protecting the deep plexus branches and the accessorius nerve. Wound irrigation and insertion of a 10-gauge Redon drain after extensive bipolar hemostasis. Two-layer wound closure after and completion of the right neck dissection without complications. Neck dissection on the left by <CLINICIAN_NAME>: Incision of the skin on the anterior edge of the sternocleidomastoid muscle (2 transverse fingers below the mandible extending mediocaudally). Separation of the subcutaneous tissue and the platysma. Subplatysmal dissection anteriorly and posteriorly. Identification of the omohyoid muscle. Dissection along the muscle up to the level of the hyoid bone. Now also identify the anterior edge of the sternocleidomastoid muscle and dissect down to the deep cervical fascia. Care is taken to preserve the branches of the cervical plexus. Identification of the accessorius nerve and release of the nerve from the cranial neck preparation. The digastric muscle is exposed in depth. Dissection along the muscle up to the level of the hyoid bone. The neck preparation is then freed from the cervical vascular nerve sheath while sparing the nerve and vascular structures. A somewhat larger, metastasis-suspicious mass is located on the accessorius nerve, which can be easily separated from the nerve during preparation. No evidence of nerve infiltration. In region II, isolated somewhat more prominent lymph nodes. Now remove the neck specimen in the usual way from cranial to caudal, sparing the deep plexus branches and the accessorius nerve. Wound irrigation and insertion of a 10-gauge Redon drain after extensive bipolar hemostasis. Two-layer wound closure after and completion of the left neck dissection without complications. After continuation of the operation and removal of the radial lobe graft, it is sutured in the palatal area and doubled in the middle section. The stalk is drained into the right side of the neck via a corridor. There the arterial anastomosis is made to the superior thyroid artery and the venous anastomosis in the form of a two-end-to-side anastomosis directly to the internal jugular vein. Finally, insertion of a Redon suction drain in both sides and an additional flap in the right side of the neck near the anastomosis. The patient was subsequently reintubated onto an 8-gauge tracheostomy tube without any problems. End of the operation. Handover of the patient to anesthesia. Conclusion: Resection of a palatal carcinoma affecting the entire soft palate with microvascular reconstruction of a radial flap graft from the left forearm and defect coverage on the left forearm with split skin from the right thigh. In addition, selective neck dissection on both sides and creation of a plastic tracheostoma.