Objective To explore the effect of prospective nursing based on predictive concept in patients with traumatic fracture combined with soft tissue defect repaired by VSD and its influence on patients' skin aesthetics. Methods A total of 60 patients with traumatic fracture combined with soft tissue defect repaired by VSD admitted to our hospital from June 2021 to December 2023 were selected as the research subjects, and they were randomly divided into control group and study group, with 30 patients in each group. The control group was given conventional nursing, and the study group was given prospective nursing based on predictive concept. The recovery indexes, skin aesthetics, satisfaction, complication and compliance were compared between the two groups. Results The wound reduction area of the study group was greater than that of the control group, the graft healing time, secondstage graft days and scar formation rate were better than those of the control group (P <0.05). After nursing, the scores of color, blood circulation, softness and thickness in the study group were lower than those in the control group (P <0.05). The satisfaction in the study group was 93.33%, which was higher than 73.33% 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 score of compliance in the study group was higher than that of the control group (P <0.05). Conclusion The application of prospective care based on predictive concept in patients with traumatic fractures combined with soft tissue defect repaired by VSD is effective, which can promote the patients' recovery and enhance skin aesthetics. It is helpful to reduce the risk of postoperative complications, and improve the patients' compliance and satisfaction.