Objective: To study the application of musculoskeletal ultrasound combined with anterolateral thigh perforator flap (ALTP) transplantation in limb wound repair. Methods: In this prospective study, 120 patients with limb wound repair who were treated in our hospital from February 2017 to January 2020 were selected as research objects. According to the principle of random grouping, the above patients were randomly divided into an observation group and a control group, with 60 cases in each group. The observation group was treated with musculoskeletal ultrasound combined with ALTP transplantation, while the control group was only treated with ALTP transplantation. The treatment effect, perioperative indicators, and complications were compared between the two groups. Results: The operation time (t=20.941, P<0.001), intraoperative blood loss (t=58.588, P<0.001) and hospitalization time (t=2.556, P=0.012) of the observation group were significantly lower than those of the control group, and there was no significant difference in the flap area between the two groups (P>0.05). The excellence and good rate of the observation group (95.00%) was significantly higher than that of the control group (81.67%), and the difference was statistically significant. There was no significant difference in donor site change, flap complications, and donor site complications between the two groups (P>0.05). Conclusion: In the treatment of limb wound repair, musculoskeletal ultrasound combined with ALTP transplantation is effective, and it is recommended to be popularized in clinic.