Oral and maxillofacial tissue defects can impose a heavy physical and psychological burden on patients. With the continuous development of microsurgical technology, free ffap and pedicled ffap transplantation have become core methods for repairing complex tissue defects. However, such surgeries have high technical requirements and delicate operations, which place strict demands on perioperative nursing, especially operating room nursing cooperation. Operating room nursing cooperation runs through the entire perioperative process, and its quality affects ffap survival rate and patient rehabilitation effect. Currently, nursing in this ffeld has problems such as insufffcient depth of specialized assessment, non-standard management of instruments and items, imprecise regulation of intraoperative vital signs, traditional team communication, and irregular postoperative handover, which restrict the improvement of nursing quality. Therefore, on the basis of sorting out the current status of perioperative nursing, this paper analyzes the main existing problems, and then constructs optimization strategies from the preoperative, intraoperative and postoperative stages, including establishing a specialized assessment system, implementing an instrument management model, strengthening intraoperative vital sign management, establishing a team communication mechanism, and optimizing the postoperative handover process, so as to improve the nursing system.