Objective To analyze the application effect of full-thickness skin graft repair in hand scar plastic surgery. Methods A total of 76 patients who underwent hand scar plastic surgery in the burn department of our hospital from October 2018 to April 2022 were selected as the research objects. According to the random number table method, they were divided into control group and observation group, with 38 patients in each group. The control group was given skin flap repair, and the observation group was given full-thickness skin graft repair. The clinical efficacy, hand rehabilitation, complications and quality of life were compared between the two groups. Results The total effective rate of treatment in the observation group was 100.00%, which was higher than 89.47% in the control group (P<0.05). The excellent and good rate of hand rehabilitation in the observation group was 94.74%, which was higher than 71.05% in the control group (P<0.05). The incidence of complications in the observation group was 7.89%, which was lower than 26.32% in the control group (P<0.05). After treatment, the scores of physiological function, physiological function, body pain and emotional function in the observation group were higher than those in the control group (P<0.05). Conclusion The application of full-thickness skin graft repair in hand scar plastic surgery is effective, which can effectively improve the patient's hand scar condition and promote the recovery of hand function. Meanwhile, the risk of postoperative complications is small and the safety is high, which is conducive to improving the quality of life of patients.