Pelvic Packing (Preperitoneal Pelvic Packing)

SOC → SCF-DBI Logic Translation

Purpose

Pelvic Packing is a damage-control surgical procedure performed to rapidly control life-threatening hemorrhage arising from pelvic fractures and pelvic vascular disruption.

The procedure achieves hemorrhage control by direct mechanical compression of bleeding surfaces within the pelvic compartment while allowing simultaneous resuscitation and physiologic stabilization.

In severe trauma, pelvic packing is one of the most important interventions for preventing death from exsanguinating pelvic hemorrhage.

SOC Definition

Clinical Objective

Control pelvic bleeding through:

• Mechanical tamponade
• Compression of venous plexuses
• Compression of cancellous bone bleeding
• Reduction of pelvic hemorrhage burden
• Facilitation of damage-control resuscitation

Common Indications

Hemodynamically Unstable Pelvic Fracture

Associated with:

• Persistent shock
• Massive transfusion requirement
• Active pelvic bleeding

Damage-Control Surgery

Patients with:

• Severe hemorrhage
• Physiologic exhaustion
• Multiple competing injuries

Combined Hemorrhage-Control Strategy

Often performed with:

• Pelvic binder
• REBOA
• Angioembolization
• Massive transfusion protocol

SCF-DBI Translation

Core Concept

SOC views Pelvic Packing as:

Mechanical tamponade of pelvic hemorrhage.

SCF-DBI views Pelvic Packing as:

Restoration of Pelvic Compartment Hemodynamic Stability Through Controlled Compression of the Pelvic Perfusion Escape Network.

The procedure is not simply packing tissue.

The procedure creates a temporary physiologic platform for:

1. Hemorrhage interruption
2. Endothelial preservation
3. Microvascular stabilization
4. Perfusion recovery
5. Pelvic tissue survival
6. Organ recovery activation

SCF-DBI Pelvic Hemorrhage Architecture

Domain 1

Pelvic Perfusion Escape Syndrome

SOC Focus

Control pelvic bleeding.

SCF-DBI Focus

Stop uncontrolled perfusion escape from the pelvic vascular network.

Hemorrhage Cascade

Pelvic fracture

↓

Vascular disruption

↓

Venous plexus bleeding

↓

Bone bleeding

↓

Retroperitoneal expansion

↓

Hemorrhagic shock

↓

Organ hypoperfusion

↓

Multi-organ collapse

SCF Classification

Pelvic Perfusion Escape Syndrome (PPES-P)

A regional hemorrhagic collapse state characterized by uncontrolled vascular leakage within the pelvic compartment.

Output

Pelvic Perfusion Escape Severity Score (PPESS)

Domain 2

Pelvic Compartment Stabilization Intelligence

SOC

Apply packing to stop hemorrhage.

SCF-DBI

Evaluate restoration of pelvic compartment stability.

Assessment Domains

Output

Pelvic Compartment Stabilization Score (PCSS)

Domain 3

Pelvic Endothelial Preservation Mapping

SCF-DBI Enhancement

Pelvic hemorrhage causes extensive:

• Endothelial injury
• Glycocalyx degradation
• Microvascular collapse

Packing aims to interrupt this progression.

Assessment Domains

Output

Pelvic Endothelial Preservation Score (PEPS)

Domain 4

Pelvic Organ Survival Assessment

SCF-DBI Enhancement

Pelvic hemorrhage threatens:

• Bladder
• Rectum
• Reproductive organs
• Pelvic musculature
• Sacral neural structures

Assessment Domains

Output

Pelvic Organ Survival Index (POSI)

Domain 5

Retroperitoneal Pressure Optimization

SCF-DBI Enhancement

Packing generates therapeutic pressure.

Too little pressure:

• Persistent hemorrhage

Too much pressure:

• Ischemic compromise

Assessment Domains

Output

Retroperitoneal Pressure Optimization Score (RPOS)

Domain 6

RHENOVA Pelvic Tissue Recovery Map

Major SCF-DBI Enhancement

Selected Enhancement:

RHENOVA Pelvic Tissue Recovery Map

This becomes the principal SCF-DBI enhancement beyond conventional pelvic packing.

Rationale

SOC focuses on:

• Bleeding control
• Survival
• Hemodynamic stabilization

SCF-DBI evaluates:

Recovery of the Entire Pelvic Tissue Ecosystem

after hemorrhage control.

Recovery Domains

Vascular Recovery

Neurologic Recovery

Musculoskeletal Recovery

Urogenital Recovery

Recovery States

Output

RHENOVA Pelvic Tissue Recovery Score (RPTRS)

Domain 7

Definitive Hemorrhage Control Transition Intelligence

SCF-DBI Enhancement

Packing is frequently a bridge to:

• Angioembolization
• Definitive fixation
• Vascular repair
• Re-exploration

Assessment Domains

Output

Definitive Control Transition Score (DCTS-P)

RHENOVA Integration

R1 — Survival Preservation

Control:

• Pelvic hemorrhage
• Shock progression
• Perfusion collapse

Output:

Pelvic Rescue Status

R2 — Recovery Optimization

Restore:

• Perfusion
• Endothelial stability
• Tissue oxygenation

Output:

Recovery Readiness Score

R3 — Regenerative Preservation

Protect:

• Pelvic soft tissues
• Neural structures
• Organ viability

Output:

Pelvic Regeneration Profile

R4 — Functional Restoration

Achieve:

• Stable pelvic physiology
• Organ preservation
• Fracture recovery integration

Output:

Pelvic Restoration Matrix

R5 — Long-Term Resilience

Prevent:

• Rebleeding
• Organ dysfunction
• Chronic pelvic disability
• Neurologic impairment

Output:

Pelvic Resilience Profile

SCF-DBI Pelvic Packing Workflow

Step 1

Identify unstable pelvic hemorrhage.

Output

Pelvic Perfusion Escape Severity Score

Step 2

Perform pelvic packing.

Output

Mechanical Tamponade Confirmation

Step 3

Assess pelvic compartment stabilization.

Output

Pelvic Compartment Stabilization Score

Step 4

Evaluate endothelial preservation.

Output

Pelvic Endothelial Preservation Score

Step 5

Assess pelvic organ survival.

Output

Pelvic Organ Survival Index

Step 6

Optimize retroperitoneal pressure balance.

Output

Retroperitoneal Pressure Optimization Score

Step 7

Generate RHENOVA Pelvic Tissue Recovery Map.

Output

RHENOVA Pelvic Tissue Recovery Score (RPTRS)

Step 8

Determine definitive hemorrhage-control transition readiness.

Output

Definitive Control Transition Score (DCTS-P)

Glossary

SCF Principle Alignment

INDEX

SCF-SURG-PELVIC-PACKING-0001

SCF-DBI-PELVIC-PERFUSION-ESCAPE-SYNDROME-0001

SCF-DBI-PELVIC-COMPARTMENT-STABILIZATION-INTELLIGENCE-0001

SCF-DBI-PELVIC-ENDOTHELIAL-PRESERVATION-MAPPING-0001

SCF-DBI-RHENOVA-PELVIC-TISSUE-RECOVERY-MAP-0001

SCF-DBI-RETROPERITONEAL-PRESSURE-OPTIMIZATION-0001

SCF-TRAUMA-PELVIC-HEMORRHAGE-WORKFLOW-0035

SCF-PELVIC-PACKING-MASTER-0001