The hand and upper extremity are particularly at risk since they are used to light and handle the fireworks. The extreme heat fireworks generate can obliterate the fingers and palm. We have seen flesh and bone burnt off or destroyed. In those cases, there is nothing left to fix or reconstruct. Blood loss can be severe, making lifelong injury almost certain. We do what we can with what's left, but a hand badly injured by fireworks is rarely ever the same, even with the extensive rehabilitation usually required after an accident.