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Summary:. Severe high-voltage electrical burns (HVEBs) to the hand can result in significant injuries, requiring early use of skin flaps or grafts for reconstruction to optimize hand function recovery. However, there is currently a lack of consensus on strategies to improve aesthetics and hand function. We reported a case of severe HVEB on the left hand that was successfully treated by a radial artery perforator flap assisted by artificial dermis (AD) and vacuum sealing drainage (VSD). In phase I, necrotic tissue was removed through debridement while preserving parabiotic tissue. The left thumb was fixed with a Kirschner wire, and the wound was covered with AD and VSD. After 2 weeks, phase II repair surgery was performed using a radial artery perforator flap to cover the wound surface. At 2 weeks after surgery, the skin flap showed good tension and no blood circulation disorders or blister formation. At 12 months after surgery, the flap had not shrunk, and its texture and color closely resembled the surrounding normal tissues. The flap also demonstrated resistance to friction, and there was nearly normal wrist joint mobility. The use of a radial artery perforator flap assisted by AD and VSD provides a simple and effective reconstruction method that preserves important vessels in the forearm, minimizes damage to local cutaneous nerves, and eliminates the need for vascular anastomosis. Therefore, this technique offers advantages in terms of aesthetics and functional improvement for severe HVEBs to the hand, although it has been rarely reported before.