Objective To analyze the application effect of evidence-based nursing combined with risk assessment strategy in the prevention and control of complications after free ffap surgery. Methods A total of 80 patients who underwent free ffap surgery in the Second Afffliated Hospital of Nanjing Medical University from January 2025 to December 2025 were selected, and they were divided into the control group and the experimental group by the random number table method, with 40 patients in each group. The control group received conventional nursing, and the experimental group received evidence-based nursing combined with risk assessment strategy on the basis of the control group. The complication rate, ffap success rate and quality of life were compared between the two groups. Results The incidence of complications in the experimental group (7.50%) was lower than that in the control group (25.00%) (P<0.05). The ffap success rate of the experimental group (97.50%) was higher than that of the control group (85.00%) (P<0.05). The scores of all dimensions of quality of life in the experimental group were higher than those in the control group after intervention (P<0.05). Conclusion Evidence-based nursing combined with risk assessment for patients after free ffap surgery can effectively reduce the incidence of complications, improve the ffap success rate, and help to enhance patients' quality of life.