Repeated pharyngoscopy and laryngoscopy as well as oral cavity inspection: The tumor can be seen, which is located exophytically in the body of the tongue, does not cross the midline, extends over the floor of the mouth onto the glossoalveolar fold, onto the tonsillar lobe, runs downwards to the end of the tonsil. Infiltration also towards the base of the tongue. This confirms the indication. The next step is transoral tumor resection. The tumor is cut around on all sides with a safety margin of 1-1.5 cm. The anterior palatal arch falls, the posterior palatal arch remains, part of the pharyngeal wall falls, the lower jaw is exposed, the posterior center of the tongue body is resected up to the midline. Parts of the base of the tongue in the upper 2/3 of the base of the tongue are also resected. The lingual nerve is preserved. Removal of the specimen in one piece, suture marking. Extra margin sample basally in the base of the tongue. Send in for frozen section. Preparation in healthy tissue, also marginal sample, thus R0 resection. Careful hemostasis. Measurement of the defect. Neck dissection on the left through <CLINICIAN_NAME> and <CLINICIAN_NAME>: incision in typical manner. Exposure of the sternocleidomastoid muscle, omohyoid muscle, digastric muscle and the infrahyoid musculature. Subsequent clearing of levels II to IV in a typical manner. Exposure of the internal jugular vein, facial vein, exposure of the internal and external carotid artery. Exposure of the accessory nerve, vagus nerve and hypoglossal nerve. Finally, careful hemostasis. Neck dissection on the right side by <CLINICIAN_NAME> and <CLINICIAN_NAME>: Same procedure as on the opposite side. Resection of the submandibular gland and levels Ib and Ia. Exposure and preservation of the facial artery, superior thyroid artery and facial vein with several outlets. Also visualization of the middle thyroid vein. This results in a level I to V evacuation on the left. Branches of the cervical plexus are exposed and preserved. Exposure of all structures as on the left side. Finally, careful hemostasis. Then elevation of the radial flap: marking of the flap length 12 cm to 12.5 cm x 6.5 cm width. Cut around the flap ulnarly, extending it cranially to the olecranon. Lifting of ulnar subfascial. Exposure of the superficial venous system, which is included. Subsequent exposure of the vascular pedicle, which is typically located on the brachioradialis muscle. Then radial incision of the flap. Subfascial elevation. Exposure of the cutaneous nerve to the lateral brachii and preservation. Distal exposure of several veins with ligation. Distal exposure of the end of the vascular pedicle. Exposure of the radial vein and radial artery. Clamp for a few minutes. Saturation always at 100 %. Then cut and treat with puncture ligatures distally and proximally. Lift the flap subfascially along the pedicle. Outgoing vessels are clipped or treated bipolar. Dissection of the vascular pedicle up to the crook of the elbow. Exposure of surface connection, deep venous system. V. cephalica is exposed in a typical manner, as well as larger veins branching off medially, a total of 2 vein ends for the anastomosis. Additional dissection of the confluence, which is also elevated and would be suitable. Exposure of the radial artery up to the entry into the brachial artery. Exposure of the previously outgoing vein and interosseous artery. This is clamped for a few minutes, no change in saturation here. Deposition and clipping or ligation. The flap is then removed and the brachial artery is treated with 6-0 Vascufil sutures. Ligation of the proximal veins. Spraying the flap with heparin solution. To cover the defect on the left forearm, split skin, thickness 0.7-0.8 mm, is removed from the thigh using the dermatome. Split skin is successively incorporated into the defect. Complete, tension-free coverage. Cranial in typical manner. Wound closure in layers. Saturation on the arm always sufficient. Between 95 and 100 %. The superficial skin defect on the thigh is treated with a hydrogel dressing. The forearm is treated with .................-Relex dressing. Then apply compresses and wrap in absorbent cotton. Fit Cramer splint and wrap in elastic bandage in functional site. Application of an arm. Saturation still > 95 %. Subsequent insertion of the radial flap into the enoral mouth defect. This is done using single Vicryl 3-0 button sutures. The flap is sutured successively into the defect without tension, partly with the sutures in place and partly with direct sutures. The flap pedicle is passed through a large tunnel. For this purpose, the digastric muscle was severed and a 3 QF tunnel was created. Tension-free and complete defect coverage. Subsequent vascular suture: facial artery not suitable as the lumen is too small. A. thyroidea superior is selected. Conditioning. Also conditioning of the radial artery. This is thickened in some places in the sense of intimal fibrosis. Fish-mouth-like incision of the superior thyroid artery, thereby equalizing the lumen. Suturing with single 8-button Ethilon sutures. After opening the clamps, good arterial flow and good venous return. Then conditioning of the V. thyroidea media and an outlet from the V. facialis. Conditioning of the 2 outlets from the superficial venous system. One outlet is anastomosed with Coupler 3.0, the second outlet with Coupler 2.5. After opening the clamps, good venous return in each case. Positive smear phenomenon. Finally, clipping of the confluence and several outlets from the superficial venous system close to the outlet. Inspection of the flap. This is well perfused. Then layered wound closure of the skin wound on the right with insertion of 2 flaps after careful hemostasis and irrigation. Layered wound closure of the skin wound on the left after irrigation and hemostasis with insertion of a Redon drainage. On the right, a marking suture is placed above the vascular pedicle for Doppler control. An 8-gauge tracheostomy tube is inserted and fixed with sutures. The flap is inspected again. This is well perfused. The procedure is completed without complications. Patient goes to the intensive care unit postoperatively ventilated. Ventilation for one night. Please continue antibiotics that were started intraoperatively for one week. Heparin, which was started intraoperatively at 500 E/h, should be continued for 5 days. Check the flap clinically and, if necessary, by Doppler according to the scheme for 5 days. Feeding for 10 days via the inserted PEG tube, followed by a gruel and then, if necessary, a diet. Overall cT3 oral cavity oropharyngeal carcinoma on the right. Awaiting the histological findings. Please leave the forearm bandage closed for 1 week, then change the bandage for the first time if there are no unusual findings.