Axillary involvement in hidradenitis suppurativa (HS) presents unique surgical challenges due to the region’s high mobility, which can hinder wound healing, as well as high recurrence rates and limited consensus on optimal closure methods. Although surgical intervention for severe HS is increasing, comparative data on closure strategies, such as secondary intention, grafts, and flaps, remain sparse, complicating standardization of care. The objective of this review was to evaluate and compare surgical outcomes of axillary HS across closure techniques, highlighting data gaps and informing treatment algorithms. A systematic literature review was conducted using PubMed with the following search string: (((axilla) AND (hidradenitis)) AND (surgical outcomes)) AND (closure). Articles published between 2010 and 2025 were screened. Included studies evaluated axillary HS treated with defined surgical closure techniques and reported on healing time, recurrence, complications, or functional outcomes. Exclusion criteria were non-English language studies, a non-axillary focus, or lack of outcome-specific data. Ten studies were included; several focused exclusively on axillary HS, though total axillary case volume was inconsistently reported. Healing by secondary intention was common, associated with fewer complications but prolonged healing. Flap-based techniques, such as thoracodorsal artery perforator (TDAP), posterior arm, parascapular, and V-Y advancement flaps, offered faster recovery and improved mobility, though donor site issues like dehiscence and seroma varied. Split-thickness skin grafts showed intermediate healing times and recurrence. One prospective study comparing TDAP flaps to secondary intention reported superior quality of life and function. Few studies used validated patient-reported outcomes or standardized recurrence definitions. This review highlights the lack of standardized outcome metrics for axillary HS and the need for validated tools to assess healing, recurrence, and patient satisfaction. The existing literature is limited by inconsistent follow-up, nonuniform recurrence definitions, and scarce utilization of patient-reported outcomes. Future research should prioritize prospective, multicenter trials using real-world data to develop evidence-based, anatomically-tailored surgical strategies.