There is lack of standardized management and mobilization strategies after oral and maxillofacial reconstruction surgery. We used prospective randomized controlled trials to explore improvements in postoperative mobilization protocol in such patients. A total of 149 patients were randomly divided into tracheotomy control group A (38 cases) and test group A (37 cases), nontracheotomy control group B (38 cases) and test group B (36 cases). Test group patients sat up in bed on the 2nd day after surgery and performed off-bed activity on the 3rd day, whereas control group patients sat up in bed on the 4th day postoperatively and performed off-bed activity on the 6th day. Objective evaluation included free flap success rate, postoperative complications, sleep time, and catheter removal time, among other parameters. Subjective evaluation included postoperative pain and comfort evaluation. The success rate of free flaps was 97.3% in test group A and 100% in the other groups. In terms of mean sleep time, 4.6 ± 1.0 h in test group A, which was longer than 4.1 ± 1.0 h in control group A (P = 0.034); 5.7 ± 1.4 h in test group B, which was longer than 4.9 ± 1.7 h in control group B (P = 0.026). Early activity makes catheter removal time (tracheal incision, nasogastric tube, urethral catheter) shorter and gets higher comfort evaluation scores in both test groups versus control groups (P < 0.05). The early mobilization protocol for patients undergoing free flap reconstruction was safe, and can effectively improve sleep, shorten the catheter indwelling time, and increase the patient's comfort level. Copyright © 2019. Published by Elsevier Ltd.