Objective To investigate the effect of local random ffap repair for wound after resection of head and face cutaneous malignant tumors. Methods A total of 120 patients undergoing wound repair after resection of head and face cutaneous malignant tumors in our hospital from January 2023 to June 2025 were selected. According to the random number table method, they were divided into the control group and the observation group, with 60 patients in each group. The control group received direct suture repair, and the observation group received local random ffap repair. The clinical efffcacy, wound repair, negative emotional state and complication rate were compared between the two groups. Results The total effective rate of treatment in the observation group was higher than that in the control group (P<0.05). The scores of wound function, color and aesthetics in the observation group were higher than those in the control group (P<0.05). The scores of SAS and SDS in the observation group were lower than those in the control group (P<0.05).The incidence of complications in the observation group (3.33%) was lower than that in the control group (5.00%), but the difference was not statistically signiffcant (P>0.05). Conclusion Local random ffap repair for wound after resection of head and face cutaneous malignant tumors can improve clinical efffcacy, effectively improve facial wound function, color and aesthetics, relieve negative emotions of patients, without increasing the incidence of complications.