Introduction: Head and neck cancers are one of common cancers with peri oral cancers are more prevailing in areas with use of tobacco, ghutka and alcohol. Peri oral soft tissue defects can occur after tumor ablation or trauma. Objectives/Aim: To assess the flap survival and oral competence in radial forearm free flap versus pedicled pectoralis major myocutaneous flap. Method: A randomized control trial was conducted at Department of Plastic Surgery BVH, Bahawalpurfrom July 2019 to December 2020. A total of 60 patients were randomly divided in two equal groups. In Group A, radial forearm free flap and in Group B pedicled pectoralis major myocutaneous flap were used for reconstruction of full-thickness defects. Data was entered and analyzed by using SPSS version 27.0. Mean and Standard Deviation were calculated for quantitative variables. Frequency and percentages were calculated for qualitative variables. Chi-square test was used to compare the flap survival and oral competence between the groups and p 0.05 which is not statistically significant. Conclusion: Radial forearm free flap is comparable option for head and neck reconstruction to the pectoralis major myocutane ous flap with fewer complication rate and overall successful outc