Objective To explore the application effect of detailed nursing in patients with defect after oral cancer resection repaired by anterolateral thigh free flap. Methods A total of 80 patients with defects after oral cancer resection repaired by anterolateral thigh free flap in our hospital from November 2022 to November 2023 were selected as the research objects. They were divided into control group and experimental group by random number table method, with 40 patients in each group. The control group was treated with routine nursing, and the experimental group was treated with detailed nursing. The clinical indexes, quality of life, nursing satisfaction, complication rate and flap survival rate were compared between the two groups. Results The hospitalization, infusion, ambulation and catheter indwelling time of the experimental group were shorter than those of the control group, and the quality of life score was higher than that of the control group (P <0.05). The scores of nursing attitude, nursing skills, nursing safety, nursing level and total satisfaction in the experimental group were higher than those in the control group (P <0.05). The incidence of complications in the experimental group was 7.50%, which was lower than 25.00% in the control group (P <0.05). The flap survival rate of the experimental group was 100.00%, which was higher than 87.50% of the control group (P <0.05). Conclusion For patients with defects after oral cancer resection repaired by anterolateral thigh free flap, detailed nursing can shorten the postoperative recovery time, reduce the incidence of complications, improve the survival rate of flap, and have high nursing satisfaction, which is worthy of clinical application.