Objective To explore the effect of composite dermal grafting and skin soft tissue expansion in scar repair treatment and the influence on scar condition. Methods A total of 86 patients who received scar repair in Xiaogan Hospital of Traditional Chinese Medicine from January 2023 to March 2024 were selected and divided into control group and experimental group according to the random number table method, with 43 patients in each group. The control group was treated with composite skin grafting, and the experimental group was treated with skin soft tissue expansion. The clinical efficacy, scar condition, quality of life, complication rate, recovery and appearance satisfaction were compared between the two groups. Results The excellent rate of treatment in the experimental group (97.67%) was higher than that in the control group (81.40%) (P <0.05). The score of VSS in the experimental group was lower than that in the control group at 3 months after operation, and the score of BSHS-B was higher than that in the control group (P <0.05). The wound healing time and blood supply recovery time in the experimental group were shorter than those in the control group (P <0.05). The incidence of complications in the experimental group (4.65%) was lower than that in the control group (20.93%) (P <0.05). The total satisfaction of appearance in the experimental group (90.70%) was higher than that in the control group (72.09%) (P <0.05). Conclusion The effect of skin soft tissue expansion in patients with scar deformity repair is good, which can improve the scar condition, increase the quality of life and appearance satisfaction, accelerate the wound healing and reduce the incidence of complications.