Objective To explore the perioperative nursing effect of lateral supramalleolar flap transplantation in repairing skin and soft tissue defects of ankle in the elderly. Methods From January 2022 to January 2023, 60 elderly patients who underwent lateral supramalleolar flap transplantation to repair skin and soft tissue defects of ankle in the Department of Wound Repair, Burn and Plastic Surgery of our hospital were randomly divided into control group and study group, with 30 patients in each group. The control group was given routine perioperative nursing, and the study group was given high-quality perioperative nursing. The nursing effect, intraoperative stress response, flap success rate, complication and quality of life were compared between the two groups. Results The total effective rate of nursing in the study group was 100.00%, which was higher than 86.67% in the control group ( P <0.05). The diastolic blood pressure, systolic blood pressure and heart rate in the study group were lower than those in the control group ( P <0.05). The success rate of skin flap in the study group was 96.67%, which was higher than 80.00% in the control group ( P <0.05). The incidence of complications in the study group was 3.33%, which was lower than 20.00% in the control group ( P <0.05). The scores of each dimension of quality of life in the study group were higher than those in the control group ( P <0.05). Conclusion High-quality perioperative nursing applied to elderly patients undergoing lateral supramalleolar flap transplantation to repair skin and soft tissue defects of ankle can improve the overall efficacy of surgery, reduce surgical stress, reduce the incidence of complications, and improve the quality of life of patients.