Objective To explore the effect of predictive nursing in patients with oral cancer after free flap repair. Methods A total of 76 patients with oral cancer who underwent free flap repair in the Department of Head and Neck Surgery, Hunan Cancer Hospital from May 2022 to May 2023 were selected as the research objects. They were divided into reference group and observation group by random number table method, with 38 patients in each group. The reference group was given routine nursing, and the observation group was given predictive nursing on the basis of the control group. The psychological status, nutritional indicators, complications, quality of life and nursing satisfaction were compared between the two groups. Results After nursing, the SAS score and SDS score of the observation group were lower than those of the reference group (P <0.05). The levels of serum albumin, transferrin and prealbumin in the observation group were higher than those in the reference group (P <0.05). The incidence of complications in the observation group was 2.63%, which was lower than 21.05% in the reference group (P <0.05). The scores of each dimension of quality of life in the observation group were higher than those in the reference group (P <0.05). The nursing satisfaction of the observation group was 100.00%, which was higher than 78.95% of the reference group (P <0.05). Conclusion Predictive nursing can effectively alleviate the negative emotions of patients with oral cancer after free flap repair, improve their nutritional status, reduce the incidence of postoperative complications, improve the quality of life, and improve nursing satisfaction, which is worthy of clinical application.