Table 1.

A list of commercial products available in the market, their significant function of use, and the advantages and disadvantages of the products.

Category	Commercial products	Function	Advantages	Disadvantages	Ref.
Fibrin Glue	Tisseel (Baxter) Evicel (Ethicon, J&J) (formerly CrosSeal in the US, and Quixil in the EU) Vitagel (Orthovita/Stryker) (replaced CoStasis (Haemacure)) CryoSeal system (ThermoGenesis) Hemaseel (Haemacure) TachoSil (Baxter) Evarrest (Ethicon, J&J) Artiss (Baxter) Biocol (LFB-Lille) Dynastat (Cohesion Corp.) Bolheal (KaketsukenPharmaceuticals) Beriplast P (Aventis Behring)	■ Hemostat and/or sealant ■ Used to prevent bleeding and leaking during or after surgical operations ■ Could be used in a range of operations including cardiovascu lar surgery, neurosurger y, gastrointest inal tract diseases, liver resection surgery	■ Biocompati ble ■ Biodegrada ble ■ Their action mimics final stages of blood coagulation cascade	■ May trigger allergic reactions ■ May cause hemorrhage ■ Risk of infections and diseases due to transmission s through biologic source ■ Could cause thromboemb olism when injection amount is not well- adjusted ■ Poor adhesion ■ Poor mechanical properties ■ Application on dry surfaces ■ Time-consuming preparation required ■ Preparation is time-intensive	[221–228]
Thrombin	Thrombin-JMI (King Pharmaceuticals) Evithrom (J&J) Recothrom (Zymogenetics) FloSeal (Baxter)	■ Creation of an insoluble clot	■ Efficient when blood presents in the area	■ May trigger allergic reactions ■ May cause hemorrhage ■ Safety concerns due to use of blood products	[228,229 ]
Collagen	FloSeal (Baxter) Avitene (C.R. Bard) TachnoComb (Pharmaceuticals International GmbH) Surgiflo (Ethicon, J&J) Proceed (Fusion Medical)	■ Hemostatic agent by promoting platelet aggregation for general surgery	■ Reduced potential of transmissio n compared to fibrin- based products ■ Biocompati ble ■ Low toxicity	■ Polymer swelling ■ May trigger allergic reactions ■ Preparation is time-intensive	[12,219,224, 230]
Chitosan	HemCon Bandage Pro ChitoFlex (HemCon)	■ Stop haemorrhage in arterial and venous bleeding ■ Antibacteri al barrier ■ For ChitoFlex, hemostatic wound dressing	■ Biocompatible ■ Biodegradable ■ Nontoxic ■ Antibacteria l properties		[85, 230]
Alginate	Sorbsan (Aspen Medical)	■ Diabetic ulcers	■ Moist environment that supports wound healing ■ Biocompati ble ■ Biodegradable ■ High wound exudate absorption ■ Promotes hemostasis	■ May trigger allergic reactions	[34, 231]
Albumin	BioGlue (Cryolife)	■ Adjunct to hemostatic methods during operations of large blood vessels	■ Fast polymerizat ion ■ Good adhesion ■ The only FDA approved product for lung resection ■ In terms of intraoperati ve and postoperative air leaks, superior compared to other methods ■ Efficient in reducing prolonged air leaks ■ Reduced hospital length of stay in comparison to using staples and sutures; thus, reduces hospitalizati on costs ■ Safe and effective	■ Toxicity concerns due to the use of aldehyde ■ Slow degradation rate, that may hinder healing ■ May trigger allergic reactions ■ Inflammatio n and scar formation	[12,15, 28]
	Progel (Davol)	■ Pleural air leak sealant for postoperati ve complications
Gelatin-Resorcin-Formaldehy de/Glutaraldehyde	GRF Biological Glue (Microval) GRFG	■ Thoracic aortic dissections ■ Multiple surgical operations	■ Strong adhesion ■ High stability ■ Do not require dry surfaces	■ Toxicity concerns due to mutagenic and carcinogenic formaldehyde ■ Slow degradation rate	[12, 28,85]
Cyanoacrylates	Dermabond (Ethicon,J&J)	■ Bond formation across opposed wound edges ■ Replaceme nt of sutures only for superficial lacerations with diameters of 5–0 or smaller. ■ Adjunct to subcutaneo us sutures	■ Easy to use ■ Strong adhesion ■ Instant adhesion due to fast polymerization ■ Rapid drying of the polymer ■ Providing Flexible water- resistant covering ■ Eliminating need for suture removal ■ Patient compliance	■ Toxicity of the degradation products ■ May cause inflammation ■ May lack of required flexibility ■ Most products are for application on dry surfaces ■ Complications due to prolonged biodegradati on for the polymers with high molecular weight and long side chains ■ Their use is limited to superficial and topical applications ■ Exothermic polymerizati on	[12, 15, 28, 232]
	Indermill (Covidien Inc.)	■ Topical skin incisions, trauma induced skin lacerations
	Histoacryl and Histoacryl Blue (B. Braun Medical Inc.)	■ Topical skin incisions, trauma induced skin lacerations
	IFABond (Ethicon,J&J)	■ Alternative to sutures and staples
	Glubran - Glubran2 (Matrix)	■ Synthetic glue for surgeries ■ For internal and external use, as a hemostatic, adhesive, sealer and bacteriostatic
Poly(ethylene glycol)	CoSeal (Baxter Bio Science Inc.)	■ Adjunct to hemostatic methods for sealing leakage areas during vascular reconstructi on	■ Non-toxic, nonimmunogen ic, and biocompati ble ■ Easy modificatio n of PEG architecture ■ Rapid gel formation	■ Tissue/nerve compression may occur due to hydrogel swelling ■ Requirement for dry surfaces for effective application ■ May trigger allergic reactions	[12, 85, 230, 233, 234]
	Duraseal (Covidien Inc.)	■ Adjunct to dural sutures to avoid cerebrospinal fluid leakage during spinal surgery ■ Vascular closure
	FocalSeal-L (Focal Inc.; Formerly AdvaSeal)	■ PEG-poly lactic acid network that stabilized mechanicall y by PEG- polytrimethylene carbonate) ■ Lung air leak sealant
	SprayGel (Covidien)	■ Gynecologi cal and colorectal operations
	OcuSeal (Hyperbranch Medical Technology)	■ Bandage in corneal transplants and lacerations
Polyurethane	TissuGlu (lysine-based polyurethane)	■ Preventing seroma formation for abdominal surgery	■ Thermal stability ■ Strong coagulation ■ Biocompatible ■ Biodegradable ■ Nontoxic ■ Controlled polymer architecture	■ Poor mechanical strength ■ Solvent/water resistance	[12, 28, 34, 85]
Poly (lactic- co-glycolic acid)	TissuePatch (TissueMed)	■ Adjunct to soft tissue sutures ■ Air leakage prevention in thoracic and dural surgery	■ Biocompatible ■ Biodegradable ■ Nontoxic ■ Ready-to- use, no need for any preparation before application ■ No risk of transmission s and infections compared to fibrin sealants		[34, 85, 230, 235]
Dendrimer	Adherus (HyperBranch Medical Technology)	■ Suture replacement for corneal wound repairs and corneal cataract incisions ■ Surgical sealant for dural, cardiovascu lar and spinal surgeries	■ No postoperative cerebrospina l fluid leaks or surgical site infections after application		[230, 236, 237]