Objective To observe the effect of volar skin superficial vein anastomosis in the treatment of patients with retrograde avulsion of the hand skin and its influence on the flap survival rate. Methods A total of 40 patients with retrograde avulsion of the hand skin admitted to Guangdong Agricultural Reclamation Center Hospital from January 2022 to January 2023 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 20 patients in each group. The control group received free flap replantation treatment, and the observation group received volar skin superficial vein anastomosis treatment. The flap survival rate, hand function and complications were compared between the two groups. Results The flap survival rate in the observation group (100.00%) was higher than that in the control group (80.00%) (P <0.05). The scores of each dimension of hand function in the two groups gradually decreased at 6, 12 and 24 months after surgery. The scores of each dimension of hand function in the observation group at 6, 12, and 24 months after surgery were all lower than those in the control group (P <0.05). The incidence of complications in the observation group (5.00%) was lower than that in the control group (30.00%) (P <0.05). Conclusion Both free flap replantation and volar skin superficial vein anastomosis can treat retrograde avulsion of the hand skin. However, volar skin superficial vein anastomosis has more advantages in improving the flap survival rate, enhancing the hand function, and reducing the incidence of complications.