Objective To construct a nursing quality evaluation indicator system for patients with skin flap transplantation and to provide a reference for the evaluation and continuous improvement of nursing quality in patients with skin flap transplantation. Methods With the three-dimensional quality structure theory as the theoretical framework, the nursing quality evaluation indicator system for patients with skin flap transplantation and indicator weights were established through literature review, expert meeting, Delphi method, and analytic hierarchy process. From October to December 2025, clinical application was carried out in departments performing flap transplantation surgeries nationwide to verify the feasibility and practicality of the indicator system. Results Two rounds of expert consultations were conducted. The expert authority coefficients were 0.941 and 0.950, respectively. The mean importance scores of all indicators were >3.50, the variation coefficients were <0.25, and the full-score rates were >20.00%. Kendall’s coefficients of concordance were 0.122 and 0.153 (P＜0.05), respectively. The final nursing quality evaluation indicator system for patients with skin flap transplantation included 3 primary indicators, 7 secondary indicators, and 18 tertiary indicators. A total of 50 departments participated in the preliminary clinical application. The Cronbach’s α coefficient of the indicator system was 0.821, the Spearman-Brown coefficient for split-half reliability was 0.773, the average content validity index of the indicator system was 0.99, and the universal content validity index was 0.83. The satisfaction questionnaire score was 21.86±2.26. Conclusion The nursing quality evaluation indicator system for patients with skin flap transplantation is feasible and practical, reflects the disease-specific characteristics of skin flap transplantation, and can be used for nursing quality management in patients with skin flap transplantation.