Purpose <p>Sensation is essential for finger pulp functionality. Our objective was to compare the sensory outcomes of forearm vs. medial foot arterialized venous flap reconstruction of finger pulp defects.</p> Methods <p>We conducted a study involving 26 arterialized venous flap reconstruction in 25 patients for finger pulp damage. The patients were categorized into two groups based on the donor site: the forearm group (<i>n</i> = 14) and the medial foot group (<i>n</i> = 12).</p> Results <p>All flaps in both the forearm and medial foot groups survived without complications. Patients in the medial foot group experienced significantly improved sensory recovery compared to those in the forearm group. The majority of cases in the forearm group exhibited venous congestion and bullae formation within 5–10 days postoperatively. Conversely, in the medial foot group, all cases were free from venous congestion or bullae formation.</p> Conclusions <p>Our findings indicate that arterialized venous flaps from the medial foot for finger pulp defect reconstruction yield superior sensory recovery outcomes compared to those from the forearm. Non-sensate arterialized venous flaps from the medial foot can provide satisfactory sensation for finger pulp coverage.</p> Clinical relevance <p>Level III. Clinical trial number: not applicable. </p>