To analyze the effects of cognitive behavioral intervention on wound healing and aesthetics in gynecological patients with open abdomen. Methods A total of 40 patients with gynecological tumors who underwent laparotomy in our hospital from January to June 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 20 patients in each group. The control group was given perioperative routine nursing intervention, and the observation group was given cognitive behavioral intervention on the basis of the control group. The satisfaction of wound aesthetics, healing and pain were compared between the two groups. Results The satisfaction with wound aesthetics in the observation group was 95.00%, which was higher than 75.00% in the control group (P <0.05). The healing rate of grade A in the observation group was higher than that in the control group, and the healing rate of grade B and grade C was lower than that in the control group (P <0.05). The incision pain score of the observation group was lower than that of the control group (P <0.05). Conclusion For patients undergoing gynecological laparotomy, cognitive behavioral intervention can accelerate wound healing, reduce wound pain, and patients have higher satisfaction with wound aesthetics.