Objective <p>To examine the outcomes of artificial dermis in repairing finger pulp defects of varying sizes, with a focus on how defect size and exposure of bone or tendon influence sensory recovery, scarring, and other clinical results.</p> Methods <p>This prospective multicenter study assessed the efficacy of Lando^® artificial dermis in 30 patients (36 fingers) treated between June 2022 and October 2023. Outcomes included sensory recovery (via Semmes-Weinstein Monofilament [SWM] and two-point discrimination [2-PD]), scarring (Vancouver Scar Scale [VSS)]), pain, and cold intolerance. Linear regressions were used to analyze associations between defect characteristics and recovery.</p> Results <p>Over a mean follow-up of 15.7 months, 14 patients reported residual numbness, with mean 2-PD of 5.9&#xa0;mm and SWM of 3.87. All patients developed scars; 20 fingers showed tissue thinning, 14 had nail deformities, and 1 developed a flexion contracture. Larger defects were linked to worse 2-PD and higher VSS scores, and exposure of bone or tendon was associated with poorer sensory recovery.</p> Conclusion <p>Artificial dermis offers reliable coverage for finger pulp defects but shows clear limitations in larger defects and those with bone or tendon exposure, where sensory recovery and aesthetic outcomes are compromised. These findings underscore the need for cautious patient selection and further comparative studies.</p>