Incision design for the excision of Dupuytren’s disease follows standard principles of hand surgery with the added complexity of managing pathologic soft tissue. Thickened fascia can displace underlying anatomy and involve skin resulting in decreased vascularity to flaps. Unfortunately, the safest surgical approaches to protect structures and maintain vascularity also pose the greatest risk of secondary contracture. Through understanding flap physiology, wound healing, and historic lessons of hand surgery, a safe and effective exposure can be designed balancing intraoperative visualization and long-term outcomes.