Skip to main content

TachoSil and Evarrest — Fibrin Sealant Patches

These patches combine human fibrinogen and thrombin with an absorbable carrier, but their carriers and indications differ. The fibrin layer adheres to the application surface; this does not establish them as interchangeable structural grafts.[1][2][6]

Composition and US Indications​

ProductCarrier and identificationUS labeled role
TachoSilEquine collagen sponge; yellow active side, off-white inactive side; Corza MedicalAdjunct to hemostasis with manual compression in cardiovascular and hepatic surgery when conventional techniques are ineffective or impractical
EvarrestOxidized regenerated cellulose plus polyglactin 910 fibers, not collagen; powdery active side and embossed inactive side; EthiconAdjunct to surgical hemostasis with manual compression when conventional techniques are ineffective or impractical

Both contain human plasma-derived proteins. Evarrest's noncollagen carrier does not make the entire product synthetic or free of blood-derived components. TachoSil contains approximately 5.5 mg/cm² fibrinogen and 2 units/cm² thrombin; these strengths should not be copied to Evarrest.[2][6]

Tunical coverage and urinary-tract sealing must be considered separately from these US hemostatic indications. Neither product replaces mechanical repair of major arterial or venous defects.

GU Reconstruction Applications​

1. Peyronie's disease — tunical defect sealing​

A reported off-label GU application. After partial plaque excision or relaxing incision on the concave side of the tunica albuginea, the tunical defect is sealed with a TachoSil patch rather than sutured graft fixation:[3][4]

  • Hatzichristodoulou sealing technique: 319 of 367 operated patients returned for long-term assessment; 93.7% immediate and 91.2% long-term complete straightness at median 47.2 months. Erectile function worsened in 15.7%. This cohort does not establish superiority over other grafts
  • PICS technique (Penile Implant with Collagen Sealing): TachoSil is applied over the tunical defect after IPP insertion in severe Peyronie's; 84% complete straightening in a retrospective multicenter series of 37 patients. Early complications occurred in 24%; one acute implant infection required explantation
  • See Peyronie's — plaque incision/grafting and Peyronie's — prosthesis with straightening

2. Other GU sealing uses​

Parenchymal or collecting-system reinforcement and urinary-diversion applications have been described, but a routine reduction in urinary leakage cannot be inferred from hemostatic indications. In particular, Farrell 2019 studied Peyronie's surgery with an implant, not partial nephrectomy: 18 patients received mixed hemostatic patches (10 Evarrest, 6 Nu-Knit and 2 TachoSil), compared retrospectively with 15 pericardium recipients. This is neither a TachoSil-specific randomized comparison nor evidence of kidney collecting-system benefit.[5]

For the operative choice between tunical grafting and implant-associated straightening, use the procedure pages linked below; do not extrapolate a small patch series into a universal first-line material.

Application and Safety​

Follow the actual product instructions; do not use a generic patch recipe.

  • TachoSil: remove contaminating fluids and disinfectants. It may be used wet or dry; on a relatively dry surface, premoisten with saline, whereas an oozing surface can activate it directly. Apply the yellow side with at least three minutes of gentle pressure using moistened gloves or a pad. The label describes 1–2 cm overlap beyond the bleeding area and at least 1 cm between overlapping patches.[6]
  • Evarrest: keep the patch dry before application, place the active surface on the visible bleeding site with the recommended overlap, and apply continuous manual compression for three minutes. Its label limits minimally invasive use when manual compression is difficult; trocar delivery is not automatically appropriate.[2]
  • Leave adherent material in place. Assess persistent bleeding and follow the product's retreatment instructions; remove unattached material as directed rather than leaving loose fragments. The August 2025 TachoSil label specifically strengthens handling and non-adherence/dislodgement precautions.[6]
  • Do not apply intravascularly or substitute for repair of major arterial/venous bleeding. Avoid use in infected/contaminated sites according to labeling. Do not pack confined spaces; compression and unwanted adhesions, including bowel obstruction, are recognized risks.[2][6]
  • Check component allergy: TachoSil is contraindicated with horse-protein or human-blood-product hypersensitivity; Evarrest is contraindicated with anaphylactic or severe systemic reactions to human blood products. Both retain a residual infectious-agent transmission risk despite processing.[2][6]

A patch may provide local hemostasis or coverage in a selected operation. It does not itself prove improved graft inosculation, preservation of penile length, or prevention of urinary leakage.

See Also​

References​

1. Rickenbacher A, Breitenstein S, Lesurtel M, Frilling A. Efficacy of TachoSil a fibrin-based haemostat in different fields of surgery — a systematic review. Expert Opin Biol Ther. 2009;9(7):897–907. doi:10.1517/14712590903029172

2. Ethicon. Evarrest Fibrin Sealant Patch: US prescribing information. Revised September 2024. Label.

3. Hatzichristodoulou G, Fiechtner S, Pyrgidis N, et al. Suture-free sealing of tunical defect with collagen fleece after partial plaque excision in 319 consecutive patients with Peyronie's disease: the sealing technique. J Urol. 2021;206(5):1276–1282. doi:10.1097/JU.0000000000001933

4. Falcone M, Preto M, Peretti F, et al. The use of collagen fleece to correct residual curvature during inflatable penile prosthesis implantation (PICS technique) in patients with complex Peyronie disease: a multicenter study. J Sex Med. 2023;20(2):229–235. doi:10.1093/jsxmed/qdac003

5. Farrell MR, Abdelsayed GA, Ziegelmann MJ, Levine LA. A comparison of hemostatic patches versus pericardium allograft for the treatment of complex Peyronie's disease with penile prosthesis and plaque incision. Urology. 2019;129:113–118. doi:10.1016/j.urology.2019.03.008

6. Corza Medical. TachoSil Fibrin Sealant Patch: US prescribing information. Revised August 2025. Label.