Objective To analyze the effect of free transplantation of anterolateral thigh perforator flap (ALTP) in patients with complex wounds and its influence on wound aesthetics. Methods A total of 60 patients with complex wounds admitted to Huaihua Hospital of Traditional Chinese Medicine from February 2023 to February 2024 were selected and divided into the control group and the observation group by the random number table method, with 30 patients in each group. The control group underwent wound repair with acellular dermal matrix (ADM) composite transplantation, and the observation group underwent wound repair with ALTP free transplantation. The repair effect, wound aesthetics, wound healing time and the incidence of postoperative complications were compared between the two groups. Results The total effective rate in the observation group (96.67%) was higher than that in the control group (73.33%) (P <0.05). The excellent and good rate of wound aesthetics in the observation group (86.67%) was higher than that in the control group (63.33%) (P <0.05). The wound healing time in the observation group was shorter than that in the control group (P <0.05). The incidence of postoperative complications in the observation group (6.67%) was lower than that in the control group (26.67%) (P <0.05). Conclusion Compared with ADM composite transplantation, the application of ALTP free transplantation for the repair of complex wounds has a better effect. It can shorten the wound healing time, promote postoperative recovery, improve the wound aesthetics, and reduce the risk of postoperative complications.