Oral and maxillofacial tissue defects impose physiological and psychological burdens on patients. With the advancement of microsurgical techniques, free and pedicled flap transplantation has become the core approach for complex defect repair. However, the procedure requires high surgical skills and stringent perioperative care, particularly in operating room nursing coordination. Operating room nursing coordination spans the entire perioperative process, and its quality directly impacts flap survival rates and patient recovery outcomes. Current nursing practices in this field are constrained by issues such as insufficient depth of specialized assessment, non-standardized management of instruments and equipment, imprecise intraoperative vital sign monitoring, traditional team communication, and non-standardized postoperative handover procedures, all of which hinder the improvement of nursing quality. To address these challenges, optimization strategies are proposed for the three phases (preoperative, intraoperative, and postoperative) to establish a specialized assessment system, implement an instrument management model, strengthen intraoperative vital management, enhance team communication mechanisms, and optimize postoperative handover processes, thereby refining the nursing system. In the future, with the integration of related technologies and the advancement of interdisciplinary simulation training, operating room nursing will evolve toward higher levels of specialization, ensuring better patient recovery outcomes.