Surgical resection is the core treatment for large, medium-sized, and refractory keloids. However, the recurrence rate of simple surgery remains high, and the standardization of perioperative nursing and postoperative management directly affects the treatment effect. Combining clinical nursing practice, this paper summarizes the key points of perioperative nursing for keloids, the optimization path of surgical plans, and multi-mode anti-recurrence nursing strategies, focusing on the core links of preoperative evaluation, intraoperative cooperation, postoperative wound care, tension control, recurrence monitoring, and psychological intervention. Research shows that refined surgical cooperation based on skin tension lines, anti-recurrence intervention within 24 hours after surgery combined with standardized nursing, and long-term dynamic follow-up can control the postoperative recurrence rate within 10%. This paper also analyzes the bottlenecks in postoperative nursing diagnosis and treatment, proposes optimization measures, and provides evidence-based reference for constructing an integrated perioperative nursing plan.