Objective To investigate the clinical efffcacy of adjacent digital artery island ffap repair for skin defect after ffnger replantation. Methods A total of 80 patients with skin defect after ffnger replantation admitted to Beijing Chaoyang Integrative Medicine Rescue and First Aid Hospital from May 2022 to June 2025 were selected as the research subjects, and they were divided into the control group and the study group by the random number table method, with 40 patients in each group. The control group received free full-thickness skin graft repair, and the study group received adjacent digital artery island ffap repair. The survival rate of grafted tissue, surgical rehabilitation indicators, repair quality of ffnger scar appearance and postoperative complication rate were compared between the two groups. Results The survival rate of grafted tissue in the study group (97.50%) was higher than that in the control group (80.00%) (P<0.05). The wound healing time and hospitalization time of the study group were shorter than those of the control group (P<0.05). The scores of PSAS, OSAS and VSS in the study group at 3 and 6 months after operation were lower than those in the control group (P<0.05). The incidence of postoperative complications in the study group (5.00%) was lower than that in the control group (20.00%) (P<0.05). Conclusion Adjacent digital artery island ffap repair applied in skin defect after ffnger replantation can effectively improve the survival rate of grafted tissue, accelerate postoperative recovery, and achieve ffat and natural scar appearance, with fewer complications, which is safe and reliable in overall clinical application.