Objective To explore the effect of specialized nursing based on the enhanced recovery after surgery concept on physical and psychological stress indicators in patients undergoing oral and maxillofacial free ffap transplantation. Methods A total of 86 patients who underwent oral and maxillofacial free ffap transplantation admitted to the Department of Otorhinolaryngology and Ophthalmology, Gansu Provincial Hospital of TCM from June 2023 to December 2024 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 43 patients in each group. The control group received conventional nursing, and the observation group received specialized nursing based on the enhanced recovery after surgery concept. The clinical related indicators, physical and psychological stress indicators, complication rate and nursing satisfaction were compared between the two groups. Results The hospitalization time and time to first postoperative meal in the observation group were shorter than those in the control group (P<0.05). The physical and psychological stress indicators of the observation group after nursing were lower than those in the control group (P<0.05). The incidence of complications in the observation group (6.98%) was lower than that in the control group (23.26%) (P<0.05). The nursing satisfaction of the observation group (97.67%) was higher than that of the control group (79.07%) (P<0.05). Conclusion The application of specialized nursing integrated with the enhanced recovery after surgeryconcept in patients undergoing oral and maxillofacial free ffap transplantation can reduce the incidence of related complications, promote the speed of postoperative recovery, and help to improve patients' nursing satisfaction.