Haemostatic / Tissue Adhesive (Biological — Human Plasma-Derived) Pregnancy: Use with caution — human plasma-derived; teratogenic risk not established but consider if alternative available.

Fibrin Glue (Tissue Adhesive — Burns/Plastics)

Brand names: Tisseel, Artiss, Evicel, Quixil

Adult dose

Dose: Applied topically to the wound/graft surface — volume determined by wound size; typically 1–10 mL per application. Artiss (slower setting) used for skin graft fixation — apply to wound bed, place graft, hold for 3 minutes

Route: Topical application (dual-syringe mixing system — fibrinogen + thrombin components combined at tip of applicator)

Frequency: Single intraoperative application

Max: As much as required to cover the wound bed — commercial kits: 1 mL, 2 mL, 5 mL sizes

Mimics final steps of coagulation cascade — fibrinogen + thrombin + factor XIII → crosslinked fibrin clot. Artiss uses human thrombin; Evicel uses bovine thrombin (bovine thrombin now less favoured due to immunogenicity). In burns: used for split-thickness skin graft (STSG) fixation to wound bed, reducing need for staples, donor site haemostasis, and securing fragile grafts on difficult surfaces (face, hands, perineum).

Paediatric dose

Route: Topical

Frequency: Single intraoperative application

Max: By wound bed area

Used in paediatric burns surgery — fibrin glue fixation of STSG reduces pain of graft change and improves take rates, especially on facial and hand burns. Safe in all paediatric age groups.

Dose adjustments

Renal

Not applicable — topical use only.

Hepatic

Not applicable.

Clinical pearls

Graft fixation superiority in burns: Artiss (slow-setting fibrin sealant — setting time ~60 sec vs Tisseel ~30 sec) designed specifically for STSG fixation — allows time to position graft accurately before adhesion. Multiple RCTs show equivalent or superior graft take rates with fibrin glue vs staples, with significantly less pain during first dressing change (no staple removal)
MHRA spray warning (2009): fatal air embolism reported when fibrin glue applied via high-pressure gas spray jet near an open blood vessel — use spray attachment at lowest possible pressure; never aim directly into a deep cavity; maintain minimum 10 cm distance. Hand application or low-pressure pump safer in most burns applications
Pathogen inactivation: Tisseel and Artiss are manufactured with solvent-detergent (S/D) treatment and heat inactivation — viral transmission risk extremely low but not zero (parvovirus B19 may not be fully inactivated by S/D)

Contraindications

Intravascular injection (absolute — can cause life-threatening thromboembolism and air embolism)
Bovine thrombin products: bovine protein allergy (use human thrombin variants instead)
Do NOT use with pressurised spray system on gas jet near open wounds — air embolism risk (MHRA warning)

Side effects

Wound infection (fibrin scaffold can support bacterial growth — ensure wound is clean)
Hypersensitivity reactions (human plasma-derived — rare allergic reactions)
Immunogenicity (bovine thrombin products can induce anti-bovine thrombin antibodies — cross-react with human thrombin in subsequent procedures)
Air embolism (spray application — use at lowest pressure possible; MHRA warning)

Interactions

Oxidising agents (betadine — inactivates fibrin glue; do not apply over iodine)

Monitoring

Graft take at 5–7 days (clinical inspection — percentage graft adherence)
Wound infection signs (odour, exudate, erythema)
Haemostasis (intraoperative — confirm adequate haemostasis with fibrin glue before dressing)

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2009 (air embolism); Tisseel/Artiss SPC; Currie et al. Burns 2013 (fibrin glue in STSG); NICE Interventional Procedures Guidance IPG537. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators