Objective To analyze the effect of whole-course reffned scar nursing combined with psychological aesthetic guidance on scar recovery in patients with extensive trauma. Methods A total of 80 patients with extensive trauma admitted to Guigang City People's Hospital from January 2025 to December 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 40 patients in each group. The control group received conventional nursing, and the observation group received whole-course reffned scar nursing combined with psychological aesthetic guidance on the basis of the control group. The recovery of psychological trauma, scar recovery and nursing satisfaction were compared between the two groups. Results After intervention, the scores of SAS, SDS and PC-PTSD-5 in the observation group were better than those in the control group (P<0.05). After intervention, the scores of scar color, vascular distribution, softness and thickness in the observation group were better than those in the control group (P<0.05). The nursing satisfaction scores of standardization of nursing operation, professionalism of scar aesthetic intervention, adaptability of psychological counseling and responsiveness of follow-up service in the observation group were better than those in the control group (P<0.05). Conclusion The application of whole-course reffned scar nursing combined with psychological aesthetic guidance for patients with extensive trauma can effectively improve the recovery of psychological trauma, promote scar recovery, and increase nursing satisfaction.