(238) THE USE OF EVARREST(TM) FIBRIN SEALANT PATCH IN PEYRONIE'S GRAFTING

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Abstract Introduction Complex and severe Peyronie’s disease often requires operative management with plaque incision/excision and grafting. Grafting materials have varied from autologous saphenous vein grafts to porcine small intestinal submucosa and cadaveric pericardium. Recently, the use of TachoSil collagen fleece has been shown to be successful. In 2012, Evarrest Fibrin Sealant was FDA approved. It has since demonstrated superior hemostatic properties and easier intraoperative use in liver and other solid organ surgeries. Objective Herein, we describe our institution’s experience with 20 patients who underwent plaque incision and grafting with Evarrest. We sought to demonstrate the feasibility of its use and describe associated complications. Methods This study was conducted via retrospective chart review at a single academic institution. A single surgeon’s case logs between 2020 and 2024 were obtained for all patients with CPT Code 54112, Plaque Incision and Grafting. Of this group, 20 patients were identified who underwent Evarrest grafting. These charts were then reviewed to determine the preoperative characteristics of their disease including curvature severity and direction and postoperative outcomes. Results The mean age was 59 ± 9 years (range 44-79) with a mean curvature of 69 degrees. Direction of curvature was most commonly dorsal (n = 14). Nine patients had a concomitant hourglass deformity. Two patients had bothersome plaques without curvature. For most patients, this was their first intervention (n = 15). After incision/excision of the plaque, defect size ranged from 1x3cm at the smallest up to 3.5x8cm at the largest. Two patients underwent simultaneous inflatable penile prosthesis placement. Penile straightening was achieved in 80% of patients, with 3 reporting mild residual curvature and 1 with severe recurrent curvature. Six patients reported numbness or paresthesia, documented at visits between 3-4 months postoperatively. Two patients had wound infections requiring oral antibiotics, and two had hematomas that required drainage. Conclusions The use of Evarrest Fibrin Sealant for Peyronie’s plaque incision and grafting procedures is feasible with acceptable post-operative outcomes. As Evarrest is more durable and easier to manipulate than Tachosil, it may serve as an appropriate alternative grafting option. Disclosure No.