Due to the wide resection range, great physiological changes, and serious impact on the appearance, speech and eating function of patients in oral and maxillofacial tumor resection surgery, perforator flap is often used to repair maxillofacial defects after tissue resection in clinical practice. However, the key to successful surgery is not only associated with the patient’s own condition and the doctor’s surgical skills, but also with good perioperative treatment. Appropriate perioperative treatment can play a positive role in the reduction of surgical complications and postoperative rehabilitation. Since the introduction of microsurgery in 1959, free flap reconstruction has been widely carried out. With the improvement of microvascular devices, the widespread use of microscopy, and the improvement of flap harvesting and microscopic techniques, the success rate of flaps has exceeded 90%. However, relatively rare flap failure or complications may still bring great trauma to patients, so perioperative management is particularly critical, especially for some surgeries with complex general conditions and perforator flaps repairing important defect sites. It is necessary to reduce the risk of flap and systemic complications by early prevention through perioperative observation, treatment and nursing. The relevant factors of the occurrence of perioperative complications include age, cardio-cerebrovascular diseases, diabetes, abnormal hepatorenal function, local vascular conditions, psychological states, use of drugs and surgical skills. Postoperative complications can be completely avoided in reconstruction surgery with perforator flap, so full preoperative evaluation, meticulous surgical operation and strict patient monitoring are important measures to prevent perioperative complications.