Background <p>Hemifacial microsomia with microtia requires complex, multi-stage reconstructive surgery that poses challenges for postoperative home care and family adaptation. Conventional perioperative nursing often fails to provide sustained guidance after discharge, increasing the risk of complications and caregiver stress. This study aimed to evaluate the effectiveness of a structured continuity-of-care program for children undergoing simultaneous hemifacial microsomia correction and ear reconstruction.</p> Methods <p>A single-center randomized controlled trial was conducted from January 2024 to June 2025. Children meeting the inclusion criteria were randomly assigned (by computer) to an intervention group or a control group (103 cases each). Due to the three-stage sequential treatment process and some loss to follow-up, 97 children in the intervention group and 93 in the control group completed the final evaluation. The control group received routine perioperative nursing care and discharge guidance, while on this basis the intervention group received an additional continuity-of-care program led by a multidisciplinary team (including pre-discharge assessment and individualized planning, high-frequency post-discharge follow-up, home environment and caregiving skills guidance, and psychological support). At T1 (the day of discharge after completing the third-stage surgery), nursing adherence, postoperative complications during the three-stage treatment, caregiver anxiety (GAD-7) and caregiver burden (ZBI) were assessed. The intervention effects were analyzed using independent-sample t tests, χ² tests, or Fisher’s exact tests.</p> Results <p>Compared with the control group, the intervention group had significantly higher scores in the three dimensions of wound care, functional exercise, and follow-up, as well as a higher total nursing adherence score (all <i>P</i> &lt; 0.05). The overall complication rate in the intervention group was 17.5%, which was lower than that of the control group (<i>P</i> = 0.028). In terms of caregivers, there was no significant difference between the intervention and control groups in the proportions of caregivers with no anxiety or mild anxiety (<i>P</i> &gt; 0.05); however, the number of caregivers with moderate or severe anxiety was significantly lower in the intervention group than in the control group (<i>P</i> &lt; 0.05). Except for the moderate burden category, the intervention group had significantly lower proportions of caregivers experiencing no burden, mild burden, and severe burden than the control group (all <i>P</i> &lt; 0.05). For specific burden subtypes, the personal strain score in the intervention group was significantly lower than that in the control group (<i>P</i> &lt; 0.05), whereas the difference in role strain scores between the two groups was not statistically significant (<i>P</i> &gt; 0.05).</p> Conclusions <p>Continuity of care can provide continuous support and guidance for patients with HFM and microtia, and is expected to improve postoperative rehabilitation outcomes, enhancing the physical and mental well-being of patients and caregivers and the quality of home care.</p> <p>Level of Evidence: Level II, risk / prognostic study.</p>