Fireworks, hands and high stakes: A plastic surgeon explains the injuries seen every Fourth of July
A plastic surgeon's words of caution, after years of treating fireworks damage in the ER

Going to barbecues, cheering for parades, wearing red, white and blue – Fourth of July traditions are time-honored and as American as apple pie. We'll take a slice of that on the holiday, too. But while fireworks are a beloved part of the weekend, it's best to leave them to the city or town displays. Many people may not realize just how many people are injured by igniting fireworks in the backyard each year.

According to one estimate from the United States Consumer Product Safety Commission (CPSC), an estimated 13,000 people were hurt by fireworks in 2025 in the U.S., and about 1,300 emergency room visits were caused by holding sparklers alone. In the two weeks before and after the Fourth of July, an average of 280 people will go to the ER each day with fireworks-related injuries, reports the American Academy of Ophthalmology, noting that most damage is done to the hands and fingers, followed by the face, ears and head. We spoke with a plastic surgeon who has treated many firework injuries to find out what happens in the ER and in the days – and sometimes weeks or even months – following an accident.

"I have treated a lot of firework injuries throughout the years," said Nicholas Kunda, MD, MBA, FACS. "They tend to peak around the Fourth of July and again at New Year's. We see fragmentation injuries with foreign bodies lodged within the hand, burn injuries, blast injuries and chemical injuries. These injuries can result in significant damage to many of the anatomical structures within the hand, including the tendons, nerves, bones and blood vessels, which may unfortunately require extensive surgery including amputations of the digits."

Treating the firework injury before reconstruction

When a patient comes into the ER with a fireworks-related injury, Dr. Kunda said trauma protocol dictates first ruling out life-threatening injuries, such as to the heart or lungs, though he noted that these are rare. The next steps are to ensure adequate perfusion (the process in which blood carries oxygen and nutrients) to the fingers and achieve temporary skeletal stabilization of any fractures to minimize motion in damaged areas. Then a days-long process of debridement begins, removing non-viable tissue that is injured beyond repair.

"That helps decrease any chance of infection and contamination from any remaining chemicals or gunpowder residue from the fireworks," said Dr. Kunda. "A lot of times, these patients undergo multiple debridements in the operating room, every 24 to 48 hours over the course of maybe a week until the wound has stabilized and is clean."

During that time, surgeons are waiting to see which tissue can survive and which becomes necrotic, meaning the tissue has died and must be removed to prevent infection.

"We delay definitive reconstructive surgery until we have achieved adequate debridement, can be sure we are out of the zone of injury and confirm no infection is present," said Dr. Kunda, adding that this is usually the case when treating many traumatic injuries, not just fireworks-related ones.

Reconstructing the hand after a fireworks injury

When a plastic surgeon is ready to begin reconstruction, the patient will need to make some decisions regarding treatment.

"Usually, there are a couple of options available to a patient, and we give our recommendation for what we have found works the best and review the risks and benefits of each option," said Dr. Kunda. "At the end of the day, it's a conversation with the patient about what they need, and what the advantages and disadvantages will be from each treatment."

Here, the disadvantage is that skin or tissue may be taken from elsewhere on the body to perform reconstructive surgery, and taking that healthy tissue can leave a scar or deformity – though plastic surgeons do their best to camouflage these in the skin's natural creases and folds. Skin may be removed from the groin, inner arm or thigh, for example, and grafted onto the hand, or a patient may need a local flap using healthy tissue from a neighboring finger or the same finger.

"We don't often take a skin graft from the thigh to put onto the finger or palm, because the skin on those areas of the hands is unique, so we frequently use local flaps, if possible, depending on the size of the defect," said Dr. Kunda.

And then there are the more intense treatments. Sometimes, the hand may need to be sutured to the chest or groin for about three to four weeks to allow the skin to incorporate. In some cases, both major blood vessels that provide nutrients, oxygen and blood flow to a finger are injured.

"That could result in necrosis of the finger, which would need to be amputated, if not treated expeditiously," said Dr. Kunda. "A finger can live off one blood vessel, without long-term side effects."

He added that the hand's function – meaning how well you can use your hand, sometimes even for everyday things like cooking or brushing your teeth – can be permanently affected by damage to the tendons, bone, joints or nerves.

A major part of a patient's treatment team is the hand therapist, who has specialized training in the rehabilitation of the hand and upper extremity and works closely with the hand surgeon to help the patient return to normal function.

"Hand therapists look at what the patient was doing beforehand," said Dr. Kunda. "What is their job? What are the major tasks they need to complete in their day-to-day life? And they use multiple treatment modalities to get the patient back to a functional standpoint for their job, family and activities of daily living."

Fireworks safety for the Fourth of July

It is important to realize that setting off fireworks at home can have long-term consequences and lead to loss of function.

There are some important guidelines to follow. Never hand a sparkler to a child – according to estimates from the American Academy of Ophthalmology, 32% of all firework-related injuries are in children under the age of 15. Do not involve alcohol. And do not, under any circumstances, look down at a tube of fireworks – eye injuries can be especially devastating, causing corneal injuries and even loss of vision.

Above all, don't assume firecrackers, rockets, sparklers or any other kind of at-home fireworks are safe just because they were sold in a store, or are legal in certain states.

"The inherent danger of fireworks is that they can explode prematurely at any time, and cause severe, irreversible injuries," said Dr. Kunda. "The biggest risk is that you don't know how well fireworks are made. Leave the fireworks displays up to the professionals."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.