Demographic and clinical details of the patients will be captured on a structured proforma.        After wide excision of the primary disease and neck dissection PMMC flap is harvested

Skin paddle marking and raising subcutaneous skin flap in both arms done with scalpel and electro cautery respectively

In Arm I myocutaneous flap elevation is done using Harmonic FOCUS shear connected to Ultrascision Harmonic generator 300(J&J)  which is calibrated at power 3 and power 5. The lateral edges of the muscle pedicle are not sutured.In Arm II electrocautery is used for myocutaneous flap tissue.The edges of muscle are sutured with absorbable suture after securing hemostasis.After elevation the flap is transferred on to the neck and the wounds are sutured with correct approximation and separate drainage kept for the neck and chest operative sites.The blood loss during flap harvesting is measured by the difference of the pre operative (Y) and post operative weight (X) of mops used during harvesting of the flap. ( X – Y) / 1.055(sp gravity blood) = volume of blood in ml.Daily monitoring of the drains with measurement done in milliliters from the neck and chest separately and  drain is removed when less than 50 ml .The cumulative volume drain volume of both neck and chest drain is recorded up to the time of removal of drain.Complication sought for at chest wound and flap recipient site1) Hematoma 2) Seroma 3)  Skin infection 4) Flap vascularity changes – partial/complete

ANALYSIS - Statistical analysis by Student t test to assess significant difference between two groups for quantitative variables such as blood loss and post operative drain.The Chi-Square test for categorical variant difference between two groups such as Hematoma, Seroma, Skin infection, Flap vascularity changes partial or complete. A P.05 was considered statistically significant.