Surgical hemostasis and tissue adherence would be significantly augmented by an effective adhesive. An ideal tissue adhesive would be widely applicable and have a variety of useful applications. An ultimate agent should have at least the following attributes. The material must be safe so that no significant dangers are associated with its application or the presence of its degradation products. The tissue adhesive must also be effective. The characteristics which are necessary include: Internal bonding strength, surface adherence strength, capacity for enhancing clot formation, and wound healing and tissue regeneration ability. The agent also needs to be readily useable within a period of minutes. The tissue adhesive should be workable so that it is easily shaped and placed in the appropriate location, yet relatively quickly solidifying. The product needs to be reasonably priced so that it is affordable and can be widely used in a cost conscious environment. Most importantly, in the United States today, the adhesive must be approvable by the Food and Drug Administration. This chapter will review the capabilities of fibrin sealant as a surgical tissue adhesive. Experience with it in more than two thousand patients at the University of Virginia Health Sciences Center will be covered in detail. The historical development of fibrin sealant begins with Bergel in 1909 who was the first to use fibrin to establish hemostasis (1). The ability of fibrinogen to function as an adhesive was noted in 1940 by Young and Medawar (2) and the development of fibrin sealant was further advanced by Cronkite, et al. (3) in 1944, when plasma fibrinogen and bovine thrombin were mixed to produce a biologic adhesive. The effectiveness of fibrin sealant was significantly enhanced in 1972 by Matras who developed a more concentrated form of fibrinogen for use in the final adhesive (4). The first commercial forms of fibrin sealant were developed in Europe and a number of different preparations are now being produced for international use. Thus far, however, these forms of fibrin sealant have not been approved for use in the United States. Although, bovine thrombin is commercially available, no source of fibrinogen is presently approved. Thus, individual hospitals have developed methods of producing fibrinogen which can be combined with bovine thrombin, factor XIII, and calcium to produce fibrin sealant. These methods vary from the use of routine American Red Cross cryoprecipitate to M ailing address: Department o f Surgery, B ox 181 University o f V irginia H ealth S cien ces Center