总结1例口腔多原发癌患者游离皮瓣移植术后并发皮瓣血管危象、出血、肺栓塞及气管软化塌陷的护理体会。针对该病例多重并发症叠加、抗凝与出血矛盾突出、肺栓塞和肺部感染导致通气功能下降，加重气道压力，诱发气管软化塌陷等护理难点，实施如下护理措施：多维度精准监测，预警皮瓣血管危象；抗凝与出血动态平衡管理，破解并发症连锁反应；阶梯式干预气管软化塌陷，构建气道安全防护体系；精准干预多重耐药感染，气道廓清阻断恶性循环。患者住院第66天带T型硅胶管出院；随访2个月，恢复良好。

To summarize the nursing experience of a patient with oral multiple primary tumors who developed flap vascular crisis，wound bleeding，pulmonary embolism，and tracheal softening collapse following free flap transplantation. The nursing challenges in this case included the superimposed multiple complications，contradiction between anticoagulation and bleeding，pulmonary embolism and pulmonary infection lead to decreased ventilation function，increased airway pressure，and induced tracheomalacia. We implemented multi-dimensional precise monitoring and early warning for vascular crisis of skin flaps，dynamic balance management of anticoagulation and hemostasis to break the chain reaction of complications，stepwise intervention for tracheal softening collapse to establish an airway safety protection system，and precision control of multi-drug resistant infections to break the vicious cycle. The patient was discharged with T-shaped silicone tube after 66 days of hospitalization and followed up for 2 month with good recovery.