Objective: To explore the clinical efficacy and safety of reverse skin flap turnover and stratified minimally invasive surgery for the treatment of bromidrosis, and compare it with traditional bromidrosis excision surgery, providing a reference for optimizing clinical surgical plans for bromidrosis. Methods: A total of 100 patients with bromidrosis admitted to the Vascular Surgery Department of our hospital from January 2024 to December 2025 were selected as the study subjects. They were randomly divided into an observation group and a control group using a random number table method, with 50 cases in each group. The control group was treated with traditional fusiform excision surgery, while the observation group was treated with reverse skin flap turnover and stratified minimally invasive surgery. Surgical-related indicators, the overall clinical treatment response rate, the incidence of postoperative complications, scar scores at 6 months postoperatively, and recurrence rates were compared between the two groups. Patient postoperative satisfaction was also recorded. Results: The observation group showed significantly better results than the control group in terms of operative time, intraoperative blood loss, and incision healing time (all p < 0.001). The overall response rate in the observation group was significantly higher than that in the control group (χ² = 5.005, p = 0.025 < 0.05). The overall incidence of complications in the observation group was significantly lower than that in the control group (χ² = 6.353, p = 0.012 < 0.05). At 6 months postoperatively, the Vancouver Scar Scale (VSS) scores and recurrence rates in the observation group were significantly lower than those in the control group, while overall patient satisfaction was significantly higher in the observation group (all p < 0.05). Conclusion: Reverse skin flap turnover and stratified minimally invasive surgery is effective for the treatment of bromidrosis. Compared with traditional surgical methods, it offers advantages such as less trauma, reduced bleeding, faster healing, a lower incidence of complications, minimal scarring, and a lower recurrence rate. It is safer and more acceptable to patients, making it suitable for clinical promotion and application.