Objective To explore the effect of solution-focused approach combined with psychological cognitive nursing on scar repair and negative emotions in patients with chronic refractory wounds. Methods A total of 60 patients with chronic refractory wounds treated in Guigang Donghui Hospital from January to December 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 30 patients in each group. The control group received conventional nursing, and the observation group was given solution-focused approach combined with psychological cognitive nursing on the basis of conventional nursing. The scar status, negative emotions and nursing satisfaction were compared between the two groups. Results After 3 months of intervention, the scores of scar color, thickness, pliability and vascular distribution in the observation group were better than those in the control group (P<0.05). The scores of SAS and SDS in the observation group after intervention were lower than those in the control group (P<0.05). The scores of service attitude, professional skill, communication efffciency, psychological support and overall satisfaction in the observation group after intervention were higher than those in the control group (P<0.05). Conclusion Solution-focused approach combined with psychological cognitive nursing can effectively improve scar repair effect in patients with chronic refractory wounds, alleviate negative emotions such as anxiety and depression, and enhance nursing satisfaction.