Fibrin Sealants — Tisseel, Evicel, Artiss
Fibrin sealants are two-component biologic adhesives that reproduce the final common pathway of coagulation at the application site — delivering concentrated fibrinogen and thrombin simultaneously through a dual-syringe applicator. When the two components meet, thrombin immediately cleaves fibrinogen to form a fibrin clot that bonds tissue, seals bleeding surfaces, and reinforces suture lines. The clot is broken down during healing; absorption depends on formulation, amount and application site.[1][2]
Product indications differ: Tisseel is a surgical hemostatic adjunct and has a specific sealing indication for colonic anastomoses after temporary colostomy reversal. Artiss is an adhesive for burn skin grafts and facial-rhytidectomy flaps, and is not indicated for hemostasis. These labels do not establish routine prevention of GU anastomotic leakage.[3][4]
Product Examples
| Product | Manufacturer | Clot formation | Distinguishing feature |
|---|---|---|---|
| Tisseel | Baxter | ~10 seconds | 500 IU/mL thrombin component; use within the actual indication and application instructions |
| Evicel | Ethicon | ~10 seconds | Purified human fibrinogen; no antifibrinolytic (no aprotinin) |
| Artiss | Baxter | ~60 seconds (slow-cure) | Low thrombin concentration (~4 IU/mL); Burn skin-graft and facial-rhytidectomy flap adhesion; not hemostasis |
| Vistaseal | Ethicon | ~10 seconds | Newer formulation with integrated spray applicator |
| Raplixa | Historical powder product | N/A | Dry formulation; confirm current local availability rather than assuming routine stock |
Mechanism
- Component A (fibrinogen + factor XIII ± aprotinin): pooled human fibrinogen at ~80 mg/mL
- Component B: thrombin solution; the listed human fibrin sealants should not be conflated with stand-alone bovine topical thrombin
- When mixed at the tissue surface:
- Thrombin cleaves fibrinogen → fibrin monomer
- Factor XIII cross-links fibrin into a stable fibrin clot
- Calcium supports the reaction
- Aprotinin (in Tisseel) slows plasmin-mediated fibrinolysis, extending clot durability
Cure time by product
- Standard (Tisseel, Evicel): ~10 seconds — near-instant
- Slow-cure (Artiss): ~60 seconds — intended to allow tissue repositioning / flap adhesion before setting
GU Reconstruction Applications and Evidence Limits
Urinary-tract suture-line reinforcement, buccal graft fixation and pelvic reconstruction uses have been reported. They require a procedure-specific rationale and are not substitutes for watertight suturing, vascularized graft contact, tension control or appropriate drainage. A generic claim that glue improves inosculation or routinely reduces urinary leaks is not established by the sources cited here.
TachoSil already carries fibrinogen and thrombin. Its tunical sealing technique is distinct from adding liquid fibrin sealant beneath a graft; do not assume a separate glue layer is necessary. See the patch companion and the operative Peyronie's pages for the described methods.
For skin-graft or flap adherence, Artiss provides up to 60 seconds of positioning time, followed by at least three minutes of gentle compression. Its labeled applications should not be generalized to every phalloplasty flap or to hemostasis.[4]
The 2025 publication of an IPP infection-prevention bundle reported 0/103 infections versus 4/115 historical controls at 12 months. The bundle changed skin preparation, sealant use and drain practice simultaneously. It does not isolate a benefit from fibrin sealant or establish a zero-infection guarantee.[2]
Application and Safety
Preparation time, thawing, warming, storage after preparation and applicator compatibility are product-specific. Follow the kit in use; there is no universal 5–10 minute preparation time or four-hour shelf life for every formulation.
- Prepare the visible surface and apply a thin, even layer. Excessive clot thickness can delay wound healing; a routine second thick coat or interposition beneath a graft is not inherently beneficial.[4]
- Gas embolism is a potentially fatal application risk. Use only the approved regulator/applicator combination, gas, pressure and working distance. EASYSPRAY must not be used in enclosed body cavities for Tisseel or Artiss; laparoscopic Tisseel delivery requires its specifically compatible system and instructions. Do not spray when the required distance cannot be assured.[3][4]
- Never inject into the circulation. Tisseel is also contraindicated for severe or brisk arterial/venous bleeding and for aprotinin hypersensitivity.[3]
- Artiss contains aprotinin too. Anaphylaxis can occur with first or repeat exposure; document prior use and component allergies.[3][4]
- Both products contain human blood-derived proteins. Confirm the individual patient's acceptance of these components; donor screening and processing reduce but do not eliminate infectious-agent risk.
- Costs and routine stock depend on the institution. Do not open expensive kits automatically for every reconstructive case without a planned indication.
Fibrin Sealant vs. Collagen-Fibrinogen Patch vs. Hemostatic Matrix
| Agent | Role |
|---|---|
| Fibrin sealant (this page) | Liquid two-component products with distinct hemostatic, sealing or adhesive indications |
| TachoSil / collagen-fibrinogen patch | Solid-phase fibrin sealant on an absorbable carrier — used for selected focal hemostatic applications; carrier and indication vary |
| FloSeal | Thrombin + gelatin matrix for selected bleeding sites within its instructions |
| Cyanoacrylates | Skin-closure products have specific external-skin restrictions; other formulations are distinct |
See Also
- Tissue sealants overview
- TachoSil / Evarrest
- FloSeal
- Penile implants — infection (reported infection-prevention bundle)
- Peyronie's — plaque incision/grafting
References
1. Spotnitz WD. Fibrin sealant: the only approved hemostat, sealant, and adhesive — a laboratory and clinical perspective. ISRN Surg. 2014;2014:203943. doi:10.1155/2014/203943
2. Fathollahi A, Razdan S, Razdan S. Zero infection protocol in inflatable penile prosthesis surgery: a prospective cohort study using chlorhexidine-alcohol skin preparation and fibrin sealant hemostasis. Int J Impot Res. 2026;38:363–367. Published online 2025. doi:10.1038/s41443-025-01174-8
3. Baxter. Tisseel Fibrin Sealant: US prescribing information. Revised September 2025. Label.
4. Baxter. Artiss Fibrin Sealant: US prescribing information. Revised September 2025. Label.