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Table 3 Ungley and Webster grading schemes combined

From: Expert consensus on the prevention, diagnosis and treatment of cold injury in China, 2020

Stage

Clinical manifestation

Ending

Lightest/A

Hyperemia and mild sensory abnormalities lasted for 2–3 days, and there were no signs and sensory abnormalities 7 days after the injury.

Generally, the walking ability can be restored quickly; the working ability can be restored in 1–2 weeks. The sensitivity to cold is occasionally increased.

Light /B

Edema, hyperemia and disappearance of sensation are still found 2–3 days after injury; 7 days after the injury, there is still abnormal sensation on the foot bottom and at the toe tip, which lasts for 4–9 weeks. No blisters or skin loss.

If the pain is not aggravated, the patient can walk; it will take 3 to 4 months to restore the working ability and hyperhidrosis. Increased cold sensitivity will remain in some patients.

Medium/C

There are still edema, hyperemia and blisters 2–3 days after injury. On the 7th day after injury, the tactile sense of the dorsum, sole and toe of the foot is not recovered, vibration and position sense are weakened, and the muscle of foot is atrophied. Edema will last 2–3 weeks, pain and hyperemia can last 2–3 months, and there is no loss of deep tissue.

In the short term, most patients need to walk with the help of equipment or others; it takes more than 6 months to 1 year to restore their working ability, and their ability to do fine motor skills is lessened or even lost. Most patients will still have hyperhidrosis and cold-sensitivity, and some will have permanent disabilities.

Severe/D

Severe edema and exudation occur 2–3 days after injury. Seven days after injury, there is still a total loss of foot sensation, muscle paralysis and atrophy, and the injury often reaches above the foot. Tissue edema lasts for 3–7 weeks, and the hyperemia and pain can last for 4 months. Tissue loss may be caused by spontaneous amputation of limbs, and gangrene is more common.

Patients needed to walk with the help of equipment or others; they are often left with permanent disabilities and rarely continue to work.