Objective To explore the effect of free radial artery wrist transverse perforator flap repair on the recovery of sensory function and aesthetics in patients with Ⅱ degree fingertip defect. Methods A total of 100 patients with Ⅱ degree fingertip defect admitted to the Second Department of Orthopedics, Huanghua Municipal People's Hospital from January 2022 to December 2023 were selected as the research subjects, and they were randomly divided into the control group and the observation group, with 50 patients in each group. The control group was given thoracoabdominal perforator flap repair treatment, and the observation group was given free radial artery wrist transverse perforator flap repair treatment. The recovery of sensory function and aesthetics were compared between the two groups. Results After intervention, the scores of sensory function, finger range of motion, thumb opposition ability and overall hand function in the observation group were all higher than those in the control group (P <0.05). The proportions of appearance color and appearance satisfaction in the observation group were higher than those in the control group, and the proportion of flap swelling was lower than that in the control group (P <0.05). Conclusion Free radial artery wrist transverse perforator flap repair can promote the recovery of upper limb function and sensation in patients with Ⅱ degree fingertip defect, and improve the aesthetics of the hand defect, which is worthy of clinical application.