Objective To explore the clinical treatment effect of radial artery perforator flap for repairing hand skin defects. Method: From May 2014 to December 2018, we used radial artery perforator flaps to repair 13 patients with hand skin defects. Among them, 3 cases were treated with radial artery perforator vascular pedicle flaps that preserved the superficial branch of the radial nerve, 5 cases were treated with free radial artery snuff pit terminal perforator flaps, and 5 cases were treated with free radial artery forearm mid distal perforator flaps. The results showed that all 13 flaps survived after surgery, including 1 case with distal venous reflux obstruction of the radial artery perforator vascular pedicle flap that retained the superficial branch of the radial nerve. The flap survived after epidermal detachment; One case of distal partial necrosis of the radial artery free flap was considered due to wound infection, and the flap survived after dressing change. Among them, 12 flaps were followed up for a period of 3-12 months, with an average of 8 months. The appearance of the flaps was not bulky, and the texture was flat and soft. According to the trial criteria for evaluating upper limb function of the Chinese Medical Association's Hand Surgery Society, 12 cases were excellent, and 1 case was good. Conclusion: The radial artery perforator vascular pedicle skin flap preserving the superficial branch of the radial nerve has rich blood supply, simple operation, flexible rotation points, and a non bulky appearance; The free radial artery snuff pit terminal perforator flap and the free radial artery forearm middle and distal perforator flap are easy to cut, do not sacrifice the main blood vessels, have minimal damage to the donor area, have a constant anatomy, and have a good recovery of the appearance, sensation, and motor function of the hands and fingers after surgery. Direct suture of the donor area is one of the feasible methods for repairing skin and soft tissue defects in the hands.