Objective To explore the effect of phased nursing based on Orem's self-care theory on postoperative recovery and psychological state in patients undergoing oral and maxillofacial free flap transplantation. Methods A total of 79 patients undergoing oral and maxillofacial free flap transplantation admitted to the Department of Otolaryngology and Ophthalmology, Gansu Provincial Hospital of TCM from June 2024 to June 2025 were selected, and they were divided into the control group (n =39) and the observation group (n =40) by the random number table method. The control group received conventional nursing, and the observation group received phased nursing based on Orem's self-care theory. The postoperative recovery, psychological state, compliance and complication rate were compared between the two groups. Results The hospitalization time and the time to first postoperative feeding in the observation group were shorter than those in the control group (P <0.05). The scores of HAMD, HAMA and MADRS in the observation group after nursing were lower than those in the control group (P <0.05). The compliance rate of the observation group (92.50%) was higher than that of the control group (74.36%) (P <0.05). The incidence of complications in the observation group (5.00%) was lower than that in the control group (23.08%) (P <0.05). Conclusion The application of phased nursing based on Orem's self-care theory for patients undergoing oral and maxillofacial free flap transplantation can effectively shorten the time to first postoperative feeding and hospitalization time, improve the patients' psychological state, enhance compliance, and help to reduce the incidence of complications.