Hidradenitis suppurativa is a chronic inflammatory skin condition characterized by painful nodules, abscesses, and sinus tracts that may lead to irreversible scarring complications. Therapeutic options include antibiotics, biologic therapies, and surgical procedures. Current management of hidradenitis suppurativa favors early surgical intervention along with medical therapy to promote healing and minimize scars and complications in a disease characterized by a therapeutic window of opportunity. Surgical techniques range from incision and drainage to wide excision, with varying recurrence rates mainly based on the extent of procedures. Reconstruction techniques would vary primarily based on the extent of the defect and the area involved. In all cases, a good preoperative planning and delimitation with imaging modalities, preferably intra- or perioperative facilitates complete removal of involved tissue, preserving the integrity and function of healthy skin and minimizing recurrences.