Liver Packing / Liver Resection

SOC → SCF-DBI Logic Translation

Purpose

Liver Packing and Liver Resection are operative interventions performed to control hepatic hemorrhage, preserve functional liver mass, restore metabolic stability, and prevent progression to hemorrhagic and metabolic collapse.

In trauma surgery, the liver is unique because it functions simultaneously as:

• A major vascular organ
• A metabolic control center
• A detoxification platform
• An immunologic regulator
• A coagulation-factor production system
• A regenerative organ

Therefore SCF-DBI views liver intervention as both a hemorrhage-control procedure and a metabolic-regenerative preservation procedure.

SOC Definition

Clinical Objective

Manage hepatic injury by:

• Controlling hemorrhage
• Preserving viable hepatic tissue
• Maintaining hepatic perfusion
• Preventing exsanguination
• Restoring physiologic stability
• Preserving long-term liver function

Common Approaches

Liver Packing

Placement of packs to:

• Compress bleeding surfaces
• Achieve tamponade
• Support damage-control surgery
• Allow physiologic recovery

Hepatorrhaphy

Direct repair of hepatic lacerations.

Non-Anatomic Resection

Removal of devitalized tissue while preserving maximal viable liver.

Anatomic Resection

Formal segmental or lobar resection when required.

Vascular Control Procedures

Examples:

• Pringle maneuver
• Selective inflow control
• Hepatic vein repair

SCF-DBI Translation

Core Concept

SOC views Liver Packing/Resection as:

Control of hepatic hemorrhage and management of liver injury.

SCF-DBI views Liver Packing/Resection as:

Preservation and Restoration of the Hepatic Metabolic-Regenerative Intelligence Network (HMRIN).

The objective extends beyond hemorrhage control.

The objective is preservation of:

1. Metabolic continuity
2. Synthetic function
3. Detoxification capacity
4. Coagulation regulation
5. Immune modulation
6. Regenerative potential

SCF-DBI Hepatic Collapse Architecture

Domain 1

Hepatic Metabolic Failure Mapping

SOC Focus

Control liver bleeding.

SCF-DBI Focus

Prevent collapse of hepatic metabolic intelligence.

Failure Cascade

Hepatic injury

↓

Hemorrhage

↓

Perfusion disruption

↓

Hepatocyte injury

↓

Metabolic dysfunction

↓

Synthetic failure

↓

Systemic physiologic instability

↓

Multi-organ dysfunction

SCF Classification

Hepatic Metabolic-Regenerative Failure Syndrome (HMRFS)

A state of physiologic instability caused by disruption of hepatic metabolic, synthetic, and regenerative systems.

Output

Hepatic Stability Severity Score (HSS-H)

Domain 2

Hepatic Regeneration Index

Major SCF-DBI Enhancement

Selected Enhancement:

Hepatic Regeneration Index (HRI)

This becomes the principal SCF-DBI enhancement for liver packing and resection.

Rationale

SOC evaluates:

• Hemostasis
• Resection margins
• Survival

SCF-DBI evaluates:

Remaining Regenerative Capacity

because long-term outcome depends on:

• Viable hepatocyte reserve
• Functional liver mass
• Regenerative activation
• Microvascular recovery

Regeneration Cascade

Hepatic preservation

↓

Viable hepatocyte retention

↓

Growth factor activation

↓

Sinusoidal remodeling

↓

Liver regeneration

↓

Functional recovery

Assessment Domains

Regeneration States

Output

Hepatic Regeneration Index (HRI)

Domain 3

Hepatic Perfusion Preservation Mapping

SCF-DBI Enhancement

Liver survival depends upon preservation of:

• Hepatic arterial flow
• Portal venous flow
• Sinusoidal circulation

Assessment Domains

Output

Hepatic Perfusion Preservation Score (HPPS)

Domain 4

Synthetic Function Recovery Intelligence

SOC

Control bleeding and preserve liver.

SCF-DBI

Quantify restoration of hepatic synthetic capability.

Assessment Domains

Output

Synthetic Recovery Score (SRS-H)

Domain 5

Hepatic Detoxification Preservation

SCF-DBI Enhancement

The liver is the body’s primary detoxification organ.

Assessment Domains

Output

Detoxification Preservation Score (DPS-H)

Domain 6

Hepatic Immune Modulation Assessment

SCF-DBI Enhancement

The liver functions as a major immunologic regulator.

Assessment Domains

Output

Hepatic Immune Modulation Score (HIMS)

Domain 7

RHENOVA Hepatic Recovery Matrix

SCF-DBI Enhancement

The objective is restoration of a functional, regenerative liver.

Recovery Domains

Hemorrhage Recovery

Metabolic Recovery

Regenerative Recovery

Output

RHENOVA Hepatic Recovery Score (RHRS)

RHENOVA Integration

R1 — Survival Preservation

Control:

• Hepatic hemorrhage
• Exsanguination
• Shock progression

Output:

Hepatic Rescue Status

R2 — Recovery Optimization

Restore:

• Perfusion
• Synthetic function
• Metabolic stability

Output:

Recovery Readiness Score

R3 — Regenerative Preservation

Protect:

• Viable hepatocytes
• Sinusoidal circulation
• Regenerative signaling pathways

Output:

Hepatic Regeneration Profile

R4 — Functional Restoration

Achieve:

• Functional liver recovery
• Coagulation normalization
• Detoxification competence

Output:

Hepatic Restoration Matrix

R5 — Long-Term Resilience

Prevent:

• Liver failure
• Coagulopathy
• Persistent metabolic dysfunction
• Regenerative insufficiency

Output:

Hepatic Resilience Profile

SCF-DBI Liver Packing / Liver Resection Workflow

Step 1

Identify hepatic injury severity and hemorrhage burden.

Output

Hepatic Stability Severity Score

Step 2

Perform liver packing, repair, or resection.

Output

Hemorrhage Control and Tissue Preservation Confirmation

Step 3

Activate Hepatic Regeneration Index.

Output

Hepatic Regeneration Index (HRI)

Step 4

Assess hepatic perfusion preservation.

Output

Hepatic Perfusion Preservation Score

Step 5

Evaluate synthetic function recovery.

Output

Synthetic Recovery Score

Step 6

Assess detoxification preservation.

Output

Detoxification Preservation Score

Step 7

Evaluate hepatic immune modulation.

Output

Hepatic Immune Modulation Score

Step 8

Generate RHENOVA Hepatic Recovery Matrix.

Output

RHENOVA Hepatic Recovery Score (RHRS)

Glossary

SCF Principle Alignment

INDEX

SCF-SURG-LIVER-PACKING-0001

SCF-SURG-LIVER-RESECTION-0001

SCF-DBI-HEPATIC-METABOLIC-REGENERATIVE-FAILURE-SYNDROME-0001

SCF-DBI-HEPATIC-REGENERATION-INDEX-0001

SCF-DBI-HEPATIC-PERFUSION-PRESERVATION-SCORE-0001

SCF-DBI-SYNTHETIC-RECOVERY-SCORE-H-0001

SCF-DBI-HEPATIC-IMMUNE-MODULATION-SCORE-0001

SCF-DBI-RHENOVA-HEPATIC-RECOVERY-MATRIX-0001

SCF-HEPATIC-TRAUMA-WORKFLOW-0042

SCF-LIVER-PACKING-RESECTION-MASTER-0001