To analyze the curative effect of modified myocutaneous flap combined with orbital septum fixation in pouch plastic surgery. Methods A total of 80 patients with pouch plastic surgery admitted to our hospital from September 2022 to September 2023 were selected as the research objects. They were divided into control group and study group by random number table method, with 40 patients in each group. The control group was treated with traditional myocutaneous flap, and the study group was treated with modified myocutaneous flap combined with orbital septum fixation. The surgical indicators, treatment satisfaction and adverse reactions were compared between the two groups. Results The operation time and the recovery time of eye in the study group were shorter than those of the control group, and the differences were statistically significant (P <0.05). The treatment satisfaction of the study group was 95.00%, which was higher than 75.00% of the control group, and the difference was statistically significant (P <0.05). The incidence of adverse reactions in the study group was 5.00%, which was lower than 60.00% in the control group, and the difference was statistically significant (P <0.05). Conclusion The effect of modified myocutaneous flap combined with orbital septum fixation in pouch plastic surgery is ideal, which is helpful for patients to shorten the operation time and the recovery time of eye. Meanwhile, the patient's treatment satisfaction is higher and the incidence of adverse reactions is lower.