Objective To explore the clinical value of palmar venous arterialization combined with external venous tension reduction in distal ffnger replantation. Methods A total of 70 patients who underwent distal ffnger replantation in our hospital from January 2023 to December 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 35 patients in each group. The control group received palmar venous arterialization, and the study group received palmar venous arterialization combined with external venous tension reduction. The perioperative indicators, ffnger motor function, aesthetic effect and complications were compared between the two groups. Results The postoperative swelling subsidence time, wound healing time and hospitalization time in the study group were shorter than those in the control group (P<0.05). At 3 months after surgery, the TAM score of the study group was higher than that of the control group, and the VSS score was lower than that of the control group (P<0.05). The incidence of complications in the study group was 5.71%, which was lower than 25.71% in the control group (P<0.05). Conclusion In distal ffnger replantation, palmar venous arterialization combined with external venous tension reduction can effectively promote postoperative recovery, and improve ffnger motor function and aesthetic effect, with high surgical safety.