Objective To compare the effect of tension reduction suture and flap transfer in the repair of maxillofacial trauma. Methods A total of 100 patients with maxillofacial trauma admitted to our hospital from December 2020 to September 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 50 patients in each group. The control group was treated with tension reduction suture, and the observation group was treated with flap transfer repair. The incidence of vascular crisis, postoperative rehabilitation index, flap swelling degree, pain degree, scar condition and wound healing effect were compared between the two groups. Results The incidence of venous crisis and arterial crisis in the observation group was lower than that in the control group (P <0.05). The length of scar in the observation group was shorter than that in the control group, and the duration of edema and incision healing time were shorter than those in the control group (P <0.05). The score of flap swelling in the observation group was lower than that in the control group at 24 and 72 h after operation (P <0.05). The VAS score of the observation group was lower than that of the control group at 72 h after operation (P <0.05). The scores of scar color, vascular distribution, softness, thickness and total score in the observation group were lower than those in the control group (P <0.05). The proportions of wound malalignment, wound dehiscence and wound infection in the observation group were lower than those in the control group (P <0.05). Conclusion The effect of flap transfer in repairing maxillofacial trauma is good, which can promote the long-term wound healing after operation and reduce the incidence of vascular crisis. It is worthy of clinical application.