Aroa Biosurgery Limited (ARX.XA) Earnings Call Transcript & Summary

[Audio Gap] Are results and update and following the company's half year now. We open all enthusiastically on for us. So it's great to be here -- into have to a little bit [indiscernible]. So I'm going to that's run through all networks [indiscernible] the half year results. On [indiscernible] presentation, I'll be [indiscernible] followed by [indiscernible] In so we start results presentation [indiscernible] [Operator Instructions] So please note that this session is being recorded. [indiscernible] Following that, we'll have [ Allison Smith, ] surgeon [indiscernible] So with that, I'm going to pass it over to James to take us through the financials for first half of the year.

Good morning, everyone. [indiscernible] the financial results for our half year 2026. So starting with revenue, revenue was $44.9 million. It was up 15% more than H1 2025. In short, we are sort of take a deeper dive in to revenue how it was made up. Gross margin, gross [indiscernible]. However, it was lying with previous [indiscernible] these increases [indiscernible] If you look at operating expenses at $39.6 million for the half, only increased $1 million, 3% from the prior year. Breaking that up, selling admin expenses were $35.5 million, an increase of [ 70% ]. This included tax on development costs of $2.6 million, decreasing from $4.3 million and in H1 FY '25. A key reason for that while this last year, we had a whole -- a large investment of costs [indiscernible] Symphony RCT but also as a result of some of this timing of the [indiscernible] activities that we are paying for the service coming to the [indiscernible]. And if we look at the remaining of sales and marketing expenses, sales and marketing expenses were $23.6 million, increase of 13% or $2.8 million. And this was primarily reflecting higher variable compensation for the sales team and also a version of the [indiscernible] U.S. tariffs as [indiscernible] R&D. R&D was $4.1 million, decrease [indiscernible] compared to the previous corresponding period and $1.3 million but in line with the prior half. And then ending the half year was a normalized EBITDA profit of $1.8 million versus [indiscernible] the previous corresponding period of [ $1.5 million. ] Turning to cash flows. So cash from operations was $4 million. [indiscernible] excess out for just $5 million for the [indiscernible] period. Cash receipts were $45 million compared to $38 million, primarily as a result of increased product sales, but we look for a lot more effective larger deals. Cash payments $41 million, decreased from $43 million in [indiscernible] period. And in terms of investing activities, investment activities were $1.6 million compared to $2.2 million, growing [indiscernible] lower capital expenditure. And then financing was pretty much in line with our previous [indiscernible]. So the group being -- as a result of the group reported a second consecutive half, but positive total cash flow, which is a significant milestone for the company sort of generate $1.5 million, ending the half year with $23.4 million in total cash. And obviously, the company remains [indiscernible]. So if we look at sales. So for our sales, $44.6 million increased 14% compared to the prior year. If we look at the [indiscernible] sales, our direct sales contributed 37% of the sales mix, this increased from 33% for both the last 2 halves [indiscernible]. And then if you look at the individual breakdown, Endoform remained relatively flat. Myriad revenue increased 33% to $19.7 million. And the Tela -- revenue to TelaBio increased 4% to margin [ $94.4 million ]. Now it's important to note that whilst we were at 4%, TelaBio's revenue [indiscernible] was 16%. The variance in that is because of last year, there was higher sales of the lower [indiscernible]. And then if we look at our sales matrix for Myriad, we continue to grow the base of customers, increasing 328 to 380, 16%, and there's [indiscernible] from March 2025, something [indiscernible]. And we also continue to increase [indiscernible] accounts [indiscernible]. And then we look at our sales force as a result of our [indiscernible] and maintaining sales force [indiscernible] sales productivity. With that, I'm going to hand it back to Brian.

[indiscernible] We're really focused on [indiscernible] sales were in the U.S. So you sort of see this in 2 parts. So there's the Aroa [indiscernible] So Myriad versus acute surgery [indiscernible] There's an outpatient component to our business. So that's been [indiscernible] business, spoke about that. It's absolutely flat. It's a high volume, relatively low value product [indiscernible] and treating likeliness -- it's been really important for us to keep that for because we've had simply [indiscernible] through the reimbursement process and the big [indiscernible] about that later. So I'd rather focus on the in-patient, but also position ourself to take advantage of [indiscernible] out-patient setting as well. For TelaBio, we're being focused on [indiscernible] so we'll go out [indiscernible] range of types of [indiscernible] about that. Then also focused on soft-tissue reconstruction in breast post [indiscernible] and instead of that [indiscernible] north of $1.3 billion [indiscernible] in the U.S. So we're pretty much a U.S-focused [indiscernible] marketing [indiscernible] sales on for the international. That is changing. We talked a little bit about that in sessions later today. So this is sort of how we see the focus for the Aroa direct team. So if you [indiscernible] procedures [indiscernible] there seem to be places that are high value [indiscernible]. So it's various -- sorry [indiscernible] forward. So that's a very important segment, [indiscernible] reconstruction on salvage. So we have to succeed [indiscernible] we have got [indiscernible] player on [indiscernible] and there is another 25 percentage [indiscernible] and all important that we look for on standard here [indiscernible] in a hospital. So we're very [indiscernible] sustain a [indiscernible] the other procedures. We are sort of positioning ourselves to be able to take advantage of option in the out-patient setting. So we'll be using our existing sales team to -- withing that process, but then also we are looking to establish a new sales team in the our-patient setting, we will look about that later. The other initiative that we have underway is that we're seeing great -- the impact of the Myriad in combination with [indiscernible] and that's driven us to [indiscernible] anticipate the [indiscernible] combination [indiscernible] live. So we're in the process of initiating that RCT, getting it up and running. We think we're going to be able to demonstrate [indiscernible] really, we [indiscernible] that is that is a very large market segment [indiscernible] deep needs news and we [indiscernible] our technology [indiscernible] opportunity there. In terms of operations, I think everyone's familiar with the company. So the Aroa direct team, the TelaBio team, large [indiscernible] the technology for our set, we've been very familiar [indiscernible] our dividends, the team knows we put it [indiscernible] So why do we manage some hospitals? And why people use our products, and that is 2 parts of [indiscernible] we can deliver clear total [indiscernible] so that is the ratable [indiscernible] small tissue, with that that we have fewer complications, using our technology, lower [indiscernible] material. And then lastly, we [indiscernible] lead to higher satisfaction for patients and higher satisfaction for [indiscernible] we can lower the direct cost of the products. So typically, our product is highest, a small discount to the market leading products. What we find is that you don't need to do some products that frequently. So often, there's such a generation of patients, [indiscernible] 2, 3, 5 times same outcome. What we're seeing with Myriad that on a mean basis, a similar action [indiscernible] So just quickly in terms of each of the product -- so I think we're making great right [indiscernible] a technology that can stabilize the hospitals [indiscernible] reconstruction. We have recently launched a niche version [indiscernible] of various success in that area. That will be an area we can see in recent growth. Certainly, we're seeing sort of changes now being proposed for next year [indiscernible] sets up a very unfavorable environment. So those changes home, we have seen basis or there is potentially a risk [indiscernible] coming out of the line. [indiscernible] very well positioned. -- sorry, certainly is very well positioned to exceptionally well. And also, we see the combination of where [indiscernible] we've got a very comprehensive portfolio there. [indiscernible] talk about that [indiscernible] I think we'll continue to see some traction with [indiscernible] we credibly valuable missions. These change of outlook. We and so very confident we enter sitting in [indiscernible] so what we have guided to [indiscernible] normalized EBITDA [indiscernible]. So in terms of key milestones for us this year, we're really focused on making good progress in [indiscernible] we're on track for that. Really clarifying value proposition for hospitals. We take the [indiscernible] in hospitals, but a lot of it comes through all that now. And sales [indiscernible] really not about getting more [indiscernible] about being more successful [indiscernible]. And the expanded through different more users in the accounts in all specialties and [indiscernible] very much on how do we look at our [indiscernible] sales team, [indiscernible] target, and we made some good progress on that. And generally, [indiscernible] in a good direction in terms of the prospect productivity. In terms of milestones, so focus on demonstrating very sustentive value. We are happy with very hard to tighter [indiscernible] on the completion of our [indiscernible], that's on roll than [indiscernible] at the end of [indiscernible] then will be and to looking for data [indiscernible] So I'm going to conclude there and open it up for questions.

[indiscernible] Just [indiscernible] as you mentioned. Can you just, I guess, out by product basis as they where you have is the fact being there. And so that the genome.

Yes. So the question problems moving out in strategy, how that work, what we're trying to do and how we're sort of bringing that to life. So [indiscernible] all successful individual hospitals. Most hospitals are passed from large hospital networks where corporate owns [indiscernible]. And so our strategy has been basically to demonstrate success and individual. And then within those hospitals development net tests that we promote to the [indiscernible]. And so we've had we've had that from a [indiscernible] perspective. But at the same time, where we've done a lot of work generating [indiscernible] show in a hospital that are producing or [indiscernible] what does that mean in early [indiscernible]. And so we've built our [indiscernible] at to the hospital and saying, the [indiscernible] bilateral to propose. And that's millions of dollars a year. And so that's something we're -- you have reactions, but you also going very iconic for the hospital. So we have been [indiscernible] the whole work in a that there's some particular [indiscernible] standout as they are very focused on a project of an looking at the pain work at a regional level term international [indiscernible] So I have to say we're working on some slow process, they move quite slowly by partner is the best of opportunity and you're [indiscernible] large volume institutions of [indiscernible] sales team [indiscernible] for ambition test, but have a lot of strong pricing as question you want to be on a [indiscernible]

[indiscernible] So in term of study, study looking at closure can [indiscernible].

[indiscernible] Of simply winning various and profile on a overengineer. [indiscernible] So that's intimately in a little bit. In terms of the analysis, so we need to analyze the data and provide an publish [indiscernible]. And so that price is below that their [indiscernible] So we own some additional data with prices [indiscernible] process. CMS provide updates in terms of that also had a of process where once most of those have defunding have been able to take the parts or 2 in the next into more both of those options start in. In terms of the changes, so CMS put out a draft in May, changes that we've made that November changes. So the changes are from products such as in ASP, which is a [indiscernible] we have environmentally see positions for our other product and online [indiscernible]. So that's the way the prices we [indiscernible] so see most slightly what we very [indiscernible] it may or may not happen this time for the other [indiscernible]. So [indiscernible] that we're assuming that [indiscernible] last year in -- when you look at seeing us as to that has changed for a long time [indiscernible] are working -- there's been mentioned -- we've seen on out of the box and so in general in the year saying that we've got reduce space. So the [indiscernible]. And then the 1st of January will be a [indiscernible] then therefore, we think that a lot of the companies that have been in this market their business models won't be sustainable after the first of January. And so we think the landscape could change dramatically and favorably for Aroa. So I think Aroa could be in a very good position if this changes after the first of January.

And then thinking about all the various sort of sites of service that, that brings into play particularly physicians office I mean how are you thinking about operationalizing that?

Yes. So a couple of ways. So our existing team, so we're focused on lower limb salvage in the inpatient setting. And so existing team will have relationships with surgeons that do procedures in their physicians office. So I think that links there for some of our team. But we're not calling on physicians, offices and LTACs and these other sites of care. So I think in order to succeed there, we really need to look at some other sales channels. And so our strategy is that we will be prepared to set up a contracted sales team on a commission-only basis from the first of January. And our thesis is that is a bunch of people that after the first of January that have previously been working in companies that were viable at the high levels of reimbursement, there may be a pool of people out there looking for their next option. And so what we'd like to do is capitalize on that and bring them on board than a [indiscernible] so as contracted salespeople.

Yes, I would have thought that the [indiscernible] is with the bulk of the Wild West.

Yes, they are -- yes, they are. I think there's 2 groups. There's [ 1099s ] that have been working in this environment over the last 4 or 5 years that have been on a commission only, doing some inpatient stuff, doing some outpatient staff. So that's part of the mix. I think -- the more interesting part of the mix is going to be people that have been in companies that have had dedicated teams where those teams [indiscernible] that's -- the economics are going to work going forward. And I think for us, they'll have established relationships with physicians, with outpatient wiring centers. And what we'd like to do is target that group to get them up and running. It may take us -- that's probably -- if this comes into place on first of January. I think everyone is kind of holding their breath to see what happens. And I think there'll be a little bit of chaos post the first of January. So it could take us 3 to 6 months to kind of get that in place. But we think that you sort of go from sort of 0 to something where you need quite a large degree of coverage. And so that seems like the most obvious option. Great. So we're -- that's first half hour. So what we're going to do now is has change it up, and we're going to have some presentations. We're going to start off with an update from TelaBio. So on the line, we have [ Tony Koblish, ] CEO of TelaBio, and we also have [ Jim Hagan, ] who's joined TelaBio recently. Jim was -- he's the Senior Vice President of Strategic and Commercial Operations and Marketing at TelaBio. He was previously a General Manager at [ Abiomed, ] where he led strategy, product innovation and business development. And we also have [ Jeff Blizzard ] on the line as well. So Jeff has been President since June 2025, he reserved on the TelaBio Board of Directors for a year until he joined as President. Prior to this role, Jeff was Global Head of Surgical Sales at [ Abiomed, ] which was a Johnson & Johnson company. So between Tony, Jeff and Jim, we've got a team here of very experienced medical device executives. So they're going to provide an update on how TelaBio is tracking. So Tony, I'm going to pass it over to you.

Thank you, Brian, and good morning, everybody. If I can get our slides up, I have just a small number of slides. And I assume the real interest here will be in the Q&A session, and please feel free to ask the 3 of us anything you would like. So I'll just add a little bit to Jeff and Jim's Bio, not to speak for them, but [ Abiomed ] arguably is 1 of the most successful med tech companies in history in terms of consecutive quarterly sales growth and overall volume of growth. And in the latter stages of that company before it got sold to J&J, it was really driven by the Surgical division. So when Jeff and Jim came into that division, there was a very small revenue at the Surgical division, maybe $15 million or so. And today, it's around $500 million. So part of the rationale for upgrading our leadership team on the commercial side is to move beyond the startup phase and the development stage. And that's had some nice results for us. It's yielded an $80-plus million business as of this year. And we want to hand the reins to them and figure out how to build this company to first $100 million business than $200 million, $300 million and maybe even up to $500 million. I think the product range that we have today, that's commercial. If you look at the proxy companies, whether it's [ Bard or LifeCell ] or some others can definitely support that level of sales, and it can particularly support that level of sales, if you look at the robust product pipeline that we have in development with Aroa. We have major new products launching in '26 with Aroa and '27 and beyond. And I can talk a little bit about those as we go through. One of the things that I think is important from what I understand from Brian, and it's very important to us that we support Aroa and Brian and that both companies and both companies, investors view this as a win-win situation. And I do think the best is still ahead of us. So the next slide, please, we can just flip through this couple of starter slides here as I get into it. So forward-looking statements. Next slide. All right. So you know our story, I think, and any questions that you have, we can fill in. This is mostly around the latest activities and the latest go-forward plan for the company. But we are a preservation and restoration company. So we think of ourselves as a soft tissue preservation and restoration company focused on hernia and breast reconstruction. So our goal here really is to eliminate or minimize the usage of first-generation products and materials. So that would be in hernia, polypropylene mesh which, in my view, has to go, there's just in 2025 after 50 to 60 years and all the known problems with that product set, our solution of a reinforced tissue matrix is the right solution going forward, and it's certainly supported by data. And then on the breast reconstruction side, first-generation [ cadaver ] skin is definitely something that we can move beyond. There's a lot of interest in alternative materials. And again, our solution with PRS and our reinforced tissue matrix is absolutely the way to go. So if you look at just some of the metrics I -- just recently, we crossed the threshold of 100,000 implantations between our hernia product set and our breast reconstruction product set. That's an awfully good number and track record to work from, and I feel like we're handing Jeff and Jim excellent clinical support and something that's truly better for patients, right? The main goal of this company is to minimize the use of these Gen 1 materials that have significant downstream adverse events for patients and take advantage of the fact that we have these next-generation technologies and just do absolutely what's best for the patient. From -- and our ratio today is about 65% hernia, 35% breast reconstruction. I think that we eventually will become a 50-50 company and that should probably start to show itself sometime in '26 and certainly into '27. On some other metrics that are important, we have well over 60 published presentations or presentations between the both product sets. There's well over 1,100 patients in peer-reviewed studies and publications. And we have well over 2,500 patients in ongoing currently active post-market clinical studies, and we're lining up to start enrolling our IDE for breast recon, goal is to get the first patient in the door by the end of this year and then start the enrollment in earnest next year. And we have most of the hospital systems, either in GPO contracts or IDN contracts. And 1 of the main features is we have about 33 individual subcontracts that are focused on the reinforced tissue matrix, which does a lot of good things for us. It puts us in our own category and moves us beyond some of the competitive bundling and rebate situations that we're up against. All right. Next slide. So I'll bring Jeff and Jim into this, and I'll sort of use this slide to talk a little bit about what we've done to strengthen the company. So by every dimension almost, we've been very intentional about setting the company up to get beyond that $200 million sales threshold. So the first thing that we've done most recently is we upgraded our Board of Directors. We brought in some new strong skill sets, particularly [ Betty Joe, ] who is a C-level executive for Advocate Health. She has 42,000 people reporting to her. And she's already in her first Board meeting given us tremendous insight into the mindset of how hospital systems think, how they contract how they interact with big companies and how they interact with small companies. So that's really critical. We've also brought in [ Bill Plovanic ] who's got a very storied track record and history of medical device analyst and also has been a CFO and a CEO at a public traded medical device company. He has a very interesting background of expanding both management operations as well as he's going to show us and lead the way in how we interact and deal with the investor community, which I think is going to be a very, very good help for us. I talked about upgrading our leadership team with Jeff and Jim. On the commercial side, we have people in place now that can professionalize our sales force, put the processes and systems in place to be able to scale the business well beyond the $80 million where we are now and get to that $200 million, $300 million, $400 million, $500 million range. That is our goal, and that's what we brought them on here for. The other thing that we've done is we've permanently strengthened our balance sheet. So the 2 [ knocks ] on TelaBio have been capital raising, burn and getting that consistent growth up into the right. So consistent sales growth up and to the right, we have a plan. We're going to start '26 off strong. I won't steal Jeff and Jim's thunder. But the balance sheet is something that we fix. So our metrics have been getting better and better quietly, I would say. But our cash consumption, our burn at the start of this year per quarter was around $10 million, and our burn cash consumption was down to about $5 million in Q3. We exited Q3 with about $30 million on the balance sheet. We got a very nice blue-chip credit facility provider [ Perceptive, ] very well known here in the U.S., very high quality to upsize our debt, replace our mid-cap debt. So that's a $40 million debt facility. So now we have an upfront upfront drawdown, which is already done [indiscernible] which nets us an additional $20 million. That debt facility can be upsized to $70 million when we hit $100 million in sales on a trailing 12-month basis. So that's another $10 million And then our largest shareholders, [indiscernible] and [ Essex Woodlands, ] have really bought into this strengthening plan, and they wanted to show support. So we opened up a small equity raise of about $13 million that was led by our largest shareholders that top up our balance sheet. So right now, we have access to -- I think it's approaching around $70 million in capital to fuel this run, this next run that we're going to get on. And if you couple that with about a $5 million cash burn in Q3, you can see that the math is starting to look better and better. And then some other metrics that are important for you guys to understand is that our ratio of sales and marketing spend to sales in Q1 was a little over 90%, and it's been steadily coming down to the point where Q3 was a little over 70%, and we expect that metric to continue to get better and better. So I think we've got a permanent solution to the balance sheet, and I think we're on our way in many ways. So I'll start from left to right. This is sort of just the simple algebra sales growth for U.S. med tech. So 5 factors that add up to growth. One is sales force size. So right now, we have historically been behind in our sales force hiring plan. Our goal in 2025 was to have about 76 reps onboard by Q2. That did not happen. We had 3 regions or so that were just poorly led and struggled with good hiring. And right now, I'm happy to say that we are at 76 and maybe even closer to 78 reps right now. So Jeff and Jim have been doing their job very well in getting high-quality sales force reps to build out, and we're going to keep building with a goal of having 90 to 95 reps hopefully by the end of Q1 or early Q2, somewhere in there. So we're going to continue to strengthen with quality and scale. And then rep productivity, it's been very good for us if you look at the cohort of reps that have been on board with this company for more than 6 months. So with our Q3 metrics, most recently, if you look at the 52 territory managers that we had on board for a minimum of 6 months. That cohort of 52 reps averaged about $1 million annualized with the range being as high as $4 million annualized for a couple of reps that we have. So we definitely can build $1 million reps, which means we can build $1.5 million and then $2 million reps on average. We have the track record and the ability to do that. But most importantly, that cohort of reps was that our internal quota plan, which is quite a bit higher than external numbers. And so the performance with tenure, with quality is there. The shortfall that we had this year was all centered on these 3 regions that were just struggling and that led well, which those leaders have been upgraded. And all the shortfall has either been in vacant territories or territories that were hired poorly and churned. So I think rep productivity is coming around and I look forward to having a bigger cohort than 52 reps for next year. On the product portfolio side, like I said, we have enough products that are commercial right now to attain our goals, but we don't want to stop there. Our goal is to have the best product portfolio that is not based on Gen 1 biomaterials, so not based on polypropylene, not based on [ cadaver ] skin in the business. And there's a very significant launch that's coming up here in the first half of '26, which is very important to Aroa, and I'm sure it's investors. So we have a long-term [indiscernible] hernia portfolio, which we're going to start to do some early cases by the end of this year. And then hopefully, with a full presentation to our national sales force at the National Sales Meeting at the end of January, and we're looking at a first half launch, that is every -- it's going to double our hernia portfolio essentially every product that we have that's reinforced with permanent polymer is going to be reinforced with PLGA, which is a long-term resorbable polymer it's a 6- to 9-month polymer. It's the same polymer that has a great track record in our PRS platform right now. And we think that, that's going to give us a tremendous match up with Bard's [ Phasix ] product and it's going to be a very important product for us. There is some some other products that are coming in '27. We have an OviTex hernia portfolio that we're working on with Aroa very closely. It's a self adhering or self gripping technology, which makes it very useful with the Intuitive robot. And hopefully, that's a '27 product that's still in development, and we still have to file [indiscernible] on that, but we very much look forward to that. And then we're getting very close to a lot of the key opinion leaders, the popes, if you will, in PRS land and hernia. And we're developing an array of products that we're calling our Signature series, which will bear the design elements directly attributable to surgeon feedback and input. And there's a nice little range of products that we can codevelop with Aroa that will continue to roll out there. And I will say that these new products have been a godsend for us, and I think have been very well -- very good for a Aroa as well. There's always a launch build to [indiscernible], which is good for Aroa. And these products generate revenue. Every new product that we've launched since the initial product range when we started commercializing has been very good with the latest being our large-sized PRS products, which I think are approaching $2 million in sales in a little less than 2 quarters for 2 SKUs, right? So there's a lot of productivity that we can get out of this product development process. And I think it does leverage the strengths of both companies. I think both companies together are stronger than 1 company could be on its own because of expertise. And our GPO contracting is just excellent. The only national 1 we don't have yet is [indiscernible]. We have a subdivision called Aptitude already lined up and approved. So whenever [indiscernible] gets around to putting out for bid, I think we'll be in good shape there. And then lastly, our clinical data is just excellent. And I know we've talked a lot about that. I won't go through all the details on that, but we have best-in-class clinical data that supports both products. And I will say on the PRS side, we did not have much clinical data until really this year. And now we have well over 500 patients in different studies to add to the great clinical data that we already had in hernia. So the next slide, please. So growth has been good. We think Jeff and Jim and this new professionalization and strengthening of our sales force can accelerate growth from here. I think our gross margins are going to be pretty steady. Target is to get around 70%. There's ups and downs in there based on accounting issues and things like that. But for the most part, I think we can rely on a 70% margin roughly. And then we believe we can reaccelerate growth as we scale and strengthen our commercial organization. So I will ask Jeff maybe to talk a little bit about his findings coming into the company and what his thoughts are and what his approach is, and certainly Jim can chime in as well. And feel free to ask us anything in the Q&A. We're happy to be as transparent as we possibly can with you all.

Thanks, Tony. For all of you I haven't met yet, nice to meet you. Good morning. My name is [ Jeff Blizzard ], just joined in June, coming off the Board for a year, as Tony said. But ultimately, the reason why I joined is this is a device and product line that's better for patients versus what's out there. It's the best product in 30-plus years and it's the most efficacious in this field. So for -- to join and take a role like this is a no-brainer, to work for a company and have a partnership with a manufacturer that ultimately yields the best product for patients is the big reason why I'm here. Secondarily, in just a point of reference [indiscernible] the patients which drive your revenue, your annuity stream as the slide focuses on second and third quarter. These are 2 record-breaking quarters for TelaBio [indiscernible] which shows the momentum of where we are headed with getting the organization focused in on the why, the patient ultimately and how they benefit. So we got in here in June. We have since assessed what we need to do. One is we had a good [indiscernible] goods field of workers that we and salespeople and clinical assistance that we needed to refine, get process instilled some discipline around the sales metrics, especially around the operating expense and start to get that down with accountability and also making sure we put in metric management. Those are some of the things that lacked and it's just part of the start-up pain that you move so quickly that you have to forgo process, which we've now instilled and bring a little bit about our [indiscernible] playbook look like and made us all accountable and successful. Secondarily was the chance to look at key markets and get great people to lead, especially in large [indiscernible] cities like city -- like Chicago, like in Los Angeles, those are key markets for us. Boston is another 1, in New York City, which was addressed before we got here in New York City is 1 of our key markets now. So we are focusing in the last quarter now in Q4 and into '26 around an academic footprint and making sure that we build on really what's worked well in New York City and other key markets across Boston and Chicago and L.A. So for us, the upside is huge knowing you've got a better for patients product that's out there. Secondarily, the total addressable market in this largest -- second largest surgical procedure done globally allows us to hunt well beyond just our contract status but also in programs that we just haven't ventured into. So what we're doing, and I'll have Jim chime in on this, but we're refining our data management. So our internal use of data, what is leveraged back to our commercial organization with a CRM tool like Salesforce to where they can become true business owners and managers and then start to build up territory plans and ultimately, even patient outcome summaries, where we can go back into programs and show you've done 8 great procedures, although the last 1 was a difficult case. Let's look at the procedures and how well they did and what work differently. So we're installing that and hopefully, will roll out in January by our national sales meeting. And then lastly is having data inside so we can address what [ MedScout ] or some of the other syndicated data resources are around the addressable markets where physicians are, and we just haven't met yet. So I'd like to introduce [ Jim Hagan, ] who comes over and I talked to him to joining with me the same day that we left at J&J, and we just saw opportunity here. So I'll let Jim tell a little bit about what we're doing next.

Thanks, Jeff, and hi, everybody. As Jeff said, I've been here since June with him as Jeff had a better sight into the company when he asked me to join. My first question was, is it a good product and he goes, it's an excellent product. And that's really all I needed to make the jump over. And as I was here, we've been able to dig in a bit deeper in terms of what makes the product special. Brian and his team came over to Boston. We met with them. I think we have a more concerted effort in '26 to really focus on the tissue and the mechanism of action. So while we are concurrently building up our field teams, we have the best possible clinical support bedside, we're going to dig in really to what makes the magic of this thing, which is the mechanism of action of the tissue and how it just acts any differently than any other hernia and plastic reconstructive products on the market today. So that's the core of our strategy in '26. As Tony mentioned, we have a critical product launch in the hernia portfolio happening in the early part of calendar year '26 with Aroa help, which should only accelerate our performance into the hernia market, where we have a right to win. But some of the other investments we are making beyond just the U.S. next year is Europe. So the U.K. specifically in Europe is our biggest single market, but we have plans to move into more Continental Europe next year, thus expanding kind of the patients we impact using the same playbook, we're implementing in the U.S. We were going to take high-powered hunters in sales profession, who are highly clinically gifted, and with the underlying sales skills we need to really break into Germany, Austria, Switzerland, the Nordics, Netherlands, is really our next entree into '26. But as Jeff said, I could not be more excited to be here right now. I think the underlying product that we share with Area is truly differentiated. We're seeing the cracks form in the U.S. market right now. And I think our upside going to 26% as we rebuild the foundation for TelaBio in the '27 and beyond is only going to get better.

So that's really the end of any presentation and -- but we'd be happy to answer any question, particularly from Jeff and Jim, I think, so you can get a feel for what we're doing and and how we're going to scale and grow this thing.

Okay. So let's open up firstly for questions from the room here and then we'll go to online attendees. So any questions for the TelaBio team.

Just to elaborate, you mentioned you're seeing cracks form in the U.S. right now. Maybe just help us better understand is that from changes in reimbursement. Is it from bigger product failings? Is it from more regulatory oversight, like help us understand what you meant by that comment?

I think if you look at the latest data coming out, really, we're up against basics, mostly in the plastics world right now. I think as more experience happens on [ Phasix ] and more publications come out and you're starting to see the recurrence rates, there's surgical site kind of infection rates really not come down from what was historic in the polypropylene era. When you overlay with our patient population who is inherently sicker and more complicated coming into procedure, our recurrence rates and our SSOs and SSIs are relatively low compared to it. So you're starting to see some users who have historically been in the polypropylene world or have been really in the biosynthetic world. With BD starting to open up to us. And I think we are really skewing into that younger generation of surgeon who is open to trying new things. They're the ones that are now starting to take us into their hospital and get us actively used within their institution. That's a foothold, once we surround that hospital with the right people that Jeff and I are putting in, that's a right to win because we have a contract already locked up, as Tony talked about. And now you're starting to see clinical belief coming through. So it's those -- it's between the publications, the anecdotal that we're hearing from some of the customers who are switching out from BD product. And just, again, the playbook, Jeff and I know that once you win clinically and you get a champion in a hospital, and you surround them with the right people who are clinically astute and get good outcomes as a relevant clinical partner [indiscernible] you start to see the takeoff happen relatively quickly after that.

I'll just add a little bit to that, sorry. So we do VIP tours for surgeons. I think the last 2 quarters, we've averaged 10 or 12 VIPs per quarter. And this year particularly, has been a market switch in the character of the surgeons coming in. A lot of them are young, fresh out of training, new attendings, looking to make a name for themselves get themselves established in their local market, grab market share. And most of these young docs are coming in with exposure to OviTex, which I think speaks back to the academic strategy that we're going to employ going forward. But I'd consider them to be dabblers familiar with the product, and they're aging to get into a full conversion situation. And generally, when they leave the VIP tour, we have a very high conversion rate to a full conversion. So as these surgeons grow in their practice, stature, procedure volumes, we're starting to get more and more full conversions. And that really has not been the case that I can -- there was the starting of it last year and maybe the year before, but this year, it's starting to to pick up momentum, and you can just feel when we bring these docs in. And they also provide us tremendous feedback on the products, their experience with the product and we use that now to inform new product development as well.

And it just to close the conversation on that is you've heard academic efforts, academic footprint. That to us is it embodies not only the teaching and training programs. So there's over about 110 general surgery programs in the U.S. and just north of 80 in plastics. We're in those programs with the key opinion leaders to show that this is a better product that these patients are coming in less despite their preoperative conditions. And then ultimately, that turns into single-center studies, turns into publications, multicenter publications. And then those opinion leaders are at our conferences next year with content on the pre-approved content on podium. We partner with them on [indiscernible]. They're teaching and training programs for not only with patients, but also their residents and what they do in [indiscernible] labs and allows us some fun to get in early with these users and build a clinical pathway with them. So when they become first year attending, as Tony cited a lot of them were seeing now. They've got this as the [indiscernible] card. They prefer this product, leaving their training programs.

I'd just like to jump in with 1 quick question. Just a couple of comments on the impact of robotic surgery in hernia repair and what's happening there?

I'll start. So if you look at the different types of hernia, it may be as high as 70-plus percent of [indiscernible] and maybe even higher in [indiscernible] are being done robotically. The robot is creeping up the complexity curve in hernia. So simple ventrals leading slowly but surely to moderate and more complex ventrals. I'm not sure if the worst of the worst [indiscernible] reconstructions are ever going to be able to be done robotically, some will. We're prepping this company like 80% at the sound barrier of maximum robot penetration of all hernias are going to be done robotically. So everything we're doing is angled around compatibility with robots. So our clinical data collection has really picked up in the last couple of years. We started off in [indiscernible] as the gateway to prove that our products were useful with the robot. There's not a lot of pushback and fight to use polypropylene up against the esophagus. So it's a pretty good spot for us to start. We were very successful there to the point where we started to get invited to the intuitive meetings like the connect meeting and some of their closed door meetings. The products are starting to find their way into some of their training programs informally, which is huge. We've got case observation sites that we've set up. I think we have 15 of those or so. Many of those mirror the intuitive case observation sites. So when surgeons go to get their time and learning on the robot. Hopefully, they're starting to see some OviTex go in as well. So we've made great strides in just getting adjacent into the robot and the whole portfolio has been set up to be compatible with the robot as far as the robot will go in hernia, which is probably 80% pretty far. And then a lot of the products in our pipeline, particularly the self gripping technology, solely designed for robot compatibility. Medtronic has a polypropylene product called Pro Grip which I think was around $30 million in sales, maybe 4, 5 years ago, it's now well over $100 million product, all driven by the robot. So I think we can catch that wave. And then some of the other products that we're working on with Aroa are some larger-sized ventral products that are really thin. Some of those technologies are based on our inguinal product, and that will start to get us into those ventral procedures as the robot creeps into ventral. So -- so far, so good. I think we got the company set up well from a data collection perspective, from a product portfolio evolution and development perspective, but also just good citizens and partnering with Intuitive in the best possible way. Whatever they allow, we do.

Great. Thanks. Look, we have to wrap it up there. So thanks, Tony, Jeff and Jim. I think what we come away from this thinking is Tela is well funded. I think we're on the track to really strong commercial growth here, and we're super excited about the next couple of years in our partnership with TelaBio.

Yes, same here the partnership with the Aroa has been great, and it's going to get better and better. So with that, I guess we'll sign off, Brian. Is that okay?

Yes. Thank you. Thanks very much.

Thank you. Thank you. Good luck, everyone. Thank you.

Okay. So what we're going to do now is transition to some talks from 2 surgeons. So we're going to start off with [ Dr. Allison Smith. ] So she is a trauma and emergency trained general surgeon. I -- do a clinical fellowship at the University of Texas, has a PhD in biomedical sciences from [indiscernible], a board certified in general surgery and surgical critical care. So she joins us today from the Louisiana State University. So Allison, thank you for joining, and look forward to your presentation.

Can everyone hear me okay?

Yes.

Great. So I think my slides are being loaded, but I just want to take this opportunity to thank you all for allowing me to participate I am wearing scrubs because I was on trauma call last night. So a lot of world work going on here. But this is a great opportunity as physicians, we don't often get to see the side of it. So I appreciate seeing the business side, but also I would like to share with you all some of my clinical experience and really give you examples of how all the work that you're doing is really paying off from the clinical side. And I was told to give you a disclaimer that some of the images our medical images. So they might be a little bit graphic. So you have been warned. The next slide, so kind of for me, Brian, did a great job introducing me kind of sums it up. But I think from my standpoint, I have been using the product for -- Myriad for about 4 years. So I did all my training in New Orleans. I specifically focused on research during my training, where I obtained not only medical degree, but a PhD. My PhD work was with wound healing and stem cells. So I've always had a strong interest in the research side. I think as a surgeon, you can do a lot to impact the patients you take care of but really research will get you to the next step and really allow you to impact more than just the patients you're taking care of. So I've appreciated my partnership with Aroa and my partners have as well because it not only allows us to use a product to help our patients, but we've also been allowed to participate in a lot of these multicenter studies that are really impacting patients above and beyond my reach in New Orleans. So that's something that's really important to me as a trauma and emergency surgeon that I'm also contributing to the greater scientific community, and I think that this product has really allowed us to do more than just taking care of our individual patients, but above and beyond and really trying to lay the groundwork for the future of regenerative medicine. Next slide. So I was just asked today to kind of speak a little bit about my experience with Myriad. And so as I mentioned, I've used the product for about 4 years. I have used other products in the past. And some of these other products, I wasn't really as well educated on them. A lot of the approaches rep will reach out to us and just say, "Hey, I've got this product, here are some great pictures. Is this something that you want to try." And we're frequently approached as physicians, and for us, it can be difficult to know what is the best because there really isn't strong literature yet to support the best approach to taking care of some of these difficult-to-treat wounds. And so when I first learned about Aroa, really the thing that appealed to me most was the company's approach. It felt more like a conversation. It wasn't so much like a sales pitch, but it was something of like we have this product, think it's going to benefit your patients. We do want you to try it. But in actuality, a big part of this was that it was affordable because that's not often the case. I work in a very poor hospital in a very poor state we take care of a lot of patients that don't have funding never will have funding. So at the end of the day, the bottom line for medical products and devices is always going to be cost. And so this is something that immediately appealed to me because it felt like something that was reachable for my patient population, but also something that seemed like it was going to benefit them. So I first started using the product just in my clinical practice, I'm a trauma surgeon. We're a busy trauma center. We take care of about almost 5,000 trauma patients per year, either off the streets of New Orleans or we have about 20% that are transfers from our state but also from surrounding states. And so we're the only Level 1 major trauma center in the New Orleans area and really the 1 in the area that also takes care of burns as well. So we get a lot of referrals for complex wounds, for trauma burn patients. So we do get quite a wide catchment area of these really difficult-to-treat wounds. So it felt like a good fit when I first learned about the product to use it in my patients. because of, again, the cost but also because it felt like something that was going to help them. and taking care of these complex wounds in my surgical training, you don't really learn a lot about how to manage wounds, even though it's something I do on a regular basis every single day. I did have at least some background from my PhD to understand how a product like Myriad would be helpful to my patients and really help them to progress along the stages of appropriate wound healing and not get stuck in the inflammatory phase like so many other patients do that never then heal their wounds. And so the product really fit well with what we needed. I liked that we also had the sheet in the [indiscernible] so really different uses for depending on what type of wounds by patients have because not all wounds come the same. Each 1 has its own unique challenges. And so this product really gave me versatility of how I could use it and depending on the approach of morsels plus the sheet, sometimes just the sheet, sometimes the morsels, it gave me the ability to decide what was best for my individual patient. Next slide. And so what I think is really important with these patients when you're taking care of them is to keep in mind that they come at you with a lot of underlying risk factors. And so a lot of the patients already come to us with wounds that are not going to heal because of comorbid conditions they have, because of lifestyle choices, because of the nature of their injuries. So this really is something that can be very difficult to treat these wounds, and it really can lead to problems that will require the patients to remain in the hospital longer, especially our patient population that have very difficult discharge disposition. I have a patient right now who unfortunately has no insurance. She's not from the United States. So therefore, she can't get any access to the resources we have, and she's had very difficult-to-treat wounds. And so Myriad has really helped us progress her longer and now she's going home on Thursday with her wound back in place, and we've applied Myriad to her several times, and we finally were able to get her complex wounds to close. And so I think that this is something really is helping us, as you can see on the slide, to help restore the tissue. You really start to see response even within 7 days, you'll start to see that. But this patient over a period of weeks, we've gradually healed her wounds, and even though she presents many challenges in terms of her body [indiscernible], her underlying illnesses, but also the fact that she's bed-bound, poor nutrition. So these are all things going against us healing these wounds. And now we've gotten hurt to the point that she's going to go home this week with her family, which is great. And she's somebody that really doesn't have other options. And so this product was able to provide her with a solution that healed her wounds and now he's going to get her back with her family. There's very minimal complications and that's something I do appreciate. When I consent patients for this procedure, I tell them, I'm going to be using this product, they -- tell them about Myriad. I do have some patients that actually Google it and they're really curious to learn about it. And most of my patients have had a really great response that they see what the product is. They're really happy that we're trying something on them because so many times, they feel like they've been given up on and they don't have people trying these products on them and that there's really no complications. I tell them, unless you're allergic to sheep, you're not going to have any complications from this. So the patients always seem to like to know that there's not a harm that's going to be posed to them. And I have had patients, as I mentioned, I take care of a lot of really complex wounds that do require multiple applications, but there's a lot of patients that you really only have to use the product once, which really helps with cost saving. And I found it superior to other products that I've tried because you can really get a good response in some of these less complicated wounds. But in the more complicated wounds, you really do see the wounds progress over a period of time even if you have to apply it more than once. Next slide. So this is a study that we took part of. As I mentioned, I've been using Myriad for about 4 years of my practice. And when we first started using the product, we were approached to be part of the clinical registry. And I will say that, that was number one, something that attracted me to the product and to the company because I do research, and I want to make sure that when I'm using a product in my patient, I'm recommending for other physicians to use it that there's research to support it. And as you all know that in the area of wound healing, there's a lot of product, but there's not a lot of really good literature to support why we're doing certain things. So I like the approach with the scientific team at Aroa that they really wanted to make sure that we're developing these studies to make sure that we are using the product that's best for our patient population. And so we participated in the clinical registry. These are patients that we see that we'd like to put Myriad in, they're adult patients only kind of for me in my patient population, a mixture of trauma patients plus acute care surgery patients, meaning patients that have things like diabetic foot ulcers, [indiscernible] pressure ulcers, necrotizing soft tissue infections. Those are the patients that we typically will use the product on outside of the trauma population. And so the patients we try to follow them for a period of several months. At minimum, we at least try to look at the wound 7 days after application. But some of these patients, we've been able to follow for months out, and we see that -- how their wounds are healing. So our data gets put with other centers so that we're able to look at how our results compare and there's power in numbers and knowing that the product works not only in my patient population, but it will work in a patient population in Northeast Georgia or in Pennsylvania or Ohio. So these are diverse patient populations that we know that this product is going to work in other places. And so the registry, we came together initially with the study -- and we have a publication that is going to be published shortly in the Journal of Trauma and Injury. And so this will be the first publication looking at that registry data in this multi-center approach. And I think that, that does speak volumes because so much of the literature in this field is really just case reports and single patient experience. And so really, our numbers show that this works in many different types of wounds and many different types of patients and different types of settings. And then the manuscript also commented on the financial advantage of this product because, again, when I approach my hospital and said, "Hey, I want to bring in a new product." First question is, how much is it going to cost us? And when I was able to show the VAC committee at my hospital who makes these decisions if I can bring in new products that not only as it's affordable or participating in a research trial with this product, and we really are going to be looking critically at our outcomes to make sure we're using the product appropriately, and we're going to be in line with other centers that are like us using the product. So once I explained all of that to them, that really carried a lot of weight and allowed us to participate in that. So I think an important part of this manuscript is that it shows that you can use this product in lots of different patient populations, but also it's financially beneficial in terms of the product cost, but also getting these patients out of the hospital sooner and back to their lives, which really is our goal for all of these patients. Next. So this shows kind of a breakdown of the patients. So it was 49 patients, but there were a total of 61 wounds because some patients had multiple wounds. About 20% of the patients had exposed structures, a vascular -- meaning they were blood vessels. The average defect size is about 100 square centimeters, which is a pretty large defect. And then about 50% of these wounds met the centers for disease control definition of being a contaminated wound, meaning that there were bacteria within the wound. So those -- again, those wounds can be very challenging to treat because there's already a pre-existing infection. And so some of the data here, you can see we used it in a lot of trauma patients and [indiscernible] in necrotizing soft tissue patients, which really can be a challenge to treat because you have a lot of exposed surface area that then you need the product to help cover. Wounds that have some [indiscernible], meaning the wound has opened up after a surgical procedure. Enterocutaneous [indiscernible] and these were my 3 patients that I have patients that have injuries to their intestines that now the intestines are exposed to the environment. And so by placing the product, we had really good results with finally closing up some of these [indiscernible] that wouldn't close other way. Pressure injuries, which this really tends to be a very marginalized population. These tend to be bed-bound patients, a lot of times older patients though we did do a sub-analysis of this data in younger trauma patients because we unfortunately have a lot of penetrating trauma where I work, a lot of patients with gunshot wounds who then end up paraplegic and bed bound and they develop these pressure ulcers even though they're very young patients. And so this also poses a very challenging patient population that this product really helps us to heal some of those wounds. We also placed it in amputation sites. So [indiscernible] I do an amputation, I like to put Myriad down the sheet down and then close the incision site. And I found that it really helps the stump to prevent having any infections after that. Patients that have had blood evacuated and then also some lower stage pressure injuries as well. Next slide. And so these are just some, again, warning graphic pictures, but not so bad. So these are just showing you some progression. And I think the field of wound healing, when you look at some of these outcomes, there's different metrics you can look at. Obviously, you want the wound to close, so you can look at wound size. That's 1 thing that you can look at time to closure, but also just looking at the wound can give you a general sense of how it's progressing. Is it getting infected? Do you see granulation tissue, which is the stages of the wound starting to heal. And is the won overall looking like it's starting to get stronger in healing. And then another thing that this looked at as well as patient satisfaction. And so how did the patients feel about these wounds. And I can tell you, in general, from my patient population, I had a lot of really grateful patients that they were able to be enrolled in this clinical registry. They felt like number one, that they were contributing to more knowledge about the field, but they also felt like somebody was finally listening to them. And I've had a lot of patients subsequently referred into me from other physicians throughout the state that say, "Hey, I've got this patient, they've got a staple pressure ulcer. Nobody has anything else to offer them. Can you help us?" And so I think that Myriad really for me is another tool in my bucket that I can use to help these patients, especially when they have been kind of written off by other surgeons who aren't able to offer them anything else. Next slide. So really kind of the key takeaways that I'd like to you all to remember from my presentation is that I think that Myriad, number one, it's safe it's affordable. Those are really 2 huge characteristics that clinicians are looking at these days, especially when health care is becoming such a difficult field with cuts to funding with a lot of hospital systems closing. It really has become difficult to get your patients what they need because the cost can be so prohibitive. And so Myriad really fills a void in the market in terms of providing that. It's something we say time and time again, where we're using it. We don't feel bad. You feel like you're really doing some of the patient without them having to have an expensive medical bill associated with it. The product works, it helps to provide soft tissue coverage, really no complications with it. And oftentimes, the wounds can [indiscernible] a single application -- but if it is a really challenging moon and it requires more than 1 application, then the cost is not prohibitive for you to continue to put the product on as needed. There's a wide variety of uses for Myriad. I think the clinical registry as it continues to grow and add cases and different sites to it is really showing that there's a wide variety of patients that this product can be used in and you find different ways to be creative with the product and really help with patients. Just another quick example. I had a patient that normally she had a bad trauma wound. We had to open up her leg. And when you try to close the [indiscernible], sometimes you have to do a skin graft take skin from another site and move it over. She had left the hospital. We tried to get her come back, but she was also kind of caught in the situation of not having funding and an ability to get that procedure. So our Myriad rep actually worked with us to get product donated to her and it helped her to hear her wound. And so again, that's just another example of kind of maybe not the typical way that I would heal that wound, but I had no other option for her. If I didn't have Myriad, you would never feel her wound. And this is a young girl, young mother had to get back to her life, and we were able to provide the ability to get her wounds healed up so she could get back to what she was doing before her trauma. So I really do believe in the product, and I do believe in the company supporting us and trying to get these patients healed because I do feel like there's a genuine interest in making the patients better and getting them back to their life. So I think that the publication when it comes out is going to show this multicenter wide variety of experience. And I know that there are other plans to do randomized controlled trials, which is something that really doesn't exist in the the wound healing world for medical literature. So I think it's great that Aroa is really tried to take this head on and design a study that's really going to help us have in evidence to when we talk with patients and families and other physicians to say, yes, this is the best product we've studied it. We really do believe in it. I think that's my last slide, if I remember correctly. And so I'm happy to answer any questions that you all may have, but thank you again for allowing me this opportunity.

Right. So let's take some questions from the room to start with. So I think we've got a question over here.

I was interested to talk to you or get your opinion on some of the discussion around potentially lower infection rates with this biologic versus other biologics on the market.

Yes. So I think the question of the infection rates, I can tell you anecdotally that it doesn't get infected, I have not seen that happen in my patients. I think where the next step or something that we've actually been studying in my lab is looking at the use of Myriad in an infected field because I think that's something that always comes up. I mean, ideally, our surgical principles, we're going to clean the wound up, try to get rid of the infection, but you ultimately can never get rid of all the bacteria. And so we actually had a study that we did in pigs last year where we looked at the use of Myriad in biofilm infected wound in a porcine model. and we found that Myriad performed really well. And I can tell you in the patients I've used it in that it's really number one, not going to contribute to the infection. And I think it really does have some of the properties that it helps to improve the eradication of infection and improvement of wound healing in an infected field. So I do think that that's kind of the next area that you really could look at this, and I've seen it clinically work well for my patients that have these kind of preexisting infections.

You said that you've been using the product for 4 years. How has your journey over that 4 years been? And -- does it take a lot of training to use a product.

Yes, I think that's a great question. So when I first started using the product, we have a really great rep who -- he was actually in my clinic this morning. He comes and check in on the patient with [indiscernible] just really cool. He just wants to see how they're doing and what we're up to. And so he would come with me to my cases. And I'd say my breadth of what I do surgically is pretty broad. So in the terms of difficulty for using Myriad, it's really not difficult. I think the thing for me as I work in an academic institution. So I work with a lot of residents that change out. So I don't have a lot of continuity in the residents helping me. So what we have designed to kind of help counteract that is we have frequent teaching sessions with the residents who are the ones that would be performing the case with me or sometimes they'll place the product if it's the wound doesn't require necessarily a surgical intervention. We just want to place Myriad, they'll place it by themselves on the floor. So the rep comes and he'll be there as a resource to help them. I'm there. A lot of my partners use Myriad quite frequently now that they're comfortable walking the residents through it. And then we have teaching Tuesday sessions, which basically every couple of months the rep will come, he'll bring product. We'll have a couple of models to demonstrate how to do it. And then I heard it mentioned earlier about the [indiscernible]. And I will say that, that's something that is really huge for -- in general, for our resident education, but also for Myriad. So last spring, we used Myriad during 1 of our [indiscernible] labs. And I think that, that was really great because it's very controlled environment. You really -- no matter how great simulators are in AI, everything we're trying to develop 3D printing nothing is as good as the [indiscernible]. Nothing is as good as using that model. And so we're lucky in that we do have access to cadaveric labs. And so we were able to have the team from Aroa come and work with us. Not only our residents, we had some community physicians as well who had interest in the product. So I do think that for our standpoint, using it is not difficult, it's just making sure that everybody is familiar with it, especially if you have trainees that come in and out and are always familiar with it. And then I would say the other piece to it was wound care nursing. And we have a great team of wound care nurses, but we're often ships in the night that they run later than I do, and I don't always see them. And so we didn't really clue them in that we were doing this. And so the first couple of times we did it the wound care nurses didn't know what we were doing. They were actually taking the Myriad off because they didn't know what it was. And so we actually have had several info sessions with them that our rep helps us to host or if we do a journal club, we invite them to it, and they've really gotten on board with it. So I do think that kind of spreading that knowledge throughout the hospital has been really helpful, and the rest of our team is supportive of us using the product.

I'm just wondering, you -- hear the product is fantastic, and you're clearly a believer in using it. I was wondering when you're talking with your colleagues or getting someone new up to scratch with using Myriad. What are the -- what sort of pushback do you get or what limitations do you find?

Yes. And that's a good question. I think from the physician side, I also heard it mentioned earlier that -- do you think there's maybe some generational differences in surgeons accepting new products. So we do have some older surgeons that some that were a little more easy to come on board, some that have been a little bit more hesitant to come on board, but that's just kind of their approach to everything. So I do think that sometimes, younger surgeons can push it a little bit just in terms of being open to trying new things. So a lot of times with my older partners is just they're kind of setting their ways, they haven't done it. And you really have to show them that this is something that could benefit them. So I think -- we take a lot of patients back and forth the operating room and cover for each other. So I think when they've seen my patients go back that I put Myriad on, that's made them really embrace it more so and know that they've seen the results and they see that it works and it offers a solution. And I think in general, the pushback is kind of probably pretty universal from most surgeons of you just -- you're skeptical of new products to some extent because we do get a lot of reps approaching us. Every day, I get an e-mail from try this product, try this product, try that product. So I do think you have as a physician, have to be able to kind of filter through that. And again, in the absence of a randomized control pile of 2,000 patients showing something superior, none of that literature exists. So you really have to be careful and really try to do your own homework and know what works best for you. So I do think from that standpoint, we are cautious in terms of what we are willing to try as a group, but also making sure that we're not just doing it just because people are offering us these free samples and things like that. So I do think we've built out kind of an algorithm that we follow, and that's really helped make a difference for some of my partners who were skeptical.

Also, I'm just wondering why in this field of medicine that there's such a lack of published data with different products.

Yes. And that's a really great question. I think there was kind of historically this explosion of products in the wound care field really in the last 10 to 20 years. So I think there was just this explosion and people were just using them left or right. And then I think hospitals, I certainly know [indiscernible] really clamped [indiscernible] because they were losing money. And so they were having these really expensive products coming in. They were expiring, people weren't using them appropriately. So I think that the market was really hot without having to support it with evidence, and then I think now that as things have changed and people have really gotten savvy to -- and hospital systems have really clamped down on this, that now you have to provide that evidence for why you're doing something. And I think that, that's hurt certain wound care products because they're just not affordable and there's no literature to support using them. So I think where this product definitely number 1 gets in is that the cost is the huge selling point, but really now trying to develop this literature to support the use of it. But I do think in this sphere that's definitely a lot of that evidence is just locking because those trials haven't been done. And they're hard to design to because you really do need probably the multicenter approach because on any given month, I only see so many [ sacral ] pressure ulcers. So it will take you time to accumulate that patient experience. So I think coordinating these multicenter studies will hopefully helpful in those gaps.

That's very useful. You mentioned some patients are sensitive to [indiscernible] material. I mean what sort of percentage of patients would finish that category? And then secondly, when would you use other products? I mean what's Myriad not perfectly suited for?

Yes. I think to address the first question. I personally have not come across anybody that's been sensitive to the ovine products. We always mention it because that is 1 of the contraindications. The closest I've come to it is I had 1 patient who's allergic to chickens. So it was kind of the only other farm animal that was maybe adjacent to a sheep. But other than that, I have not come across anybody that has had a hypersensitivity reaction or a known sheep allergy. So that would be a new 1 for me. So I think for the most part, you can use it pretty liberally and there's really not any way to exclude it. I think what I'm excited for is I really like the idea of having like a biologic scaffold that might help more as a bridge to skin grafting in some of these wounds. So in some of the other products that I've used in the past that has been synthetic, which I'm not as much [indiscernible] because I do think the biologic material really contributes to the overall wound healing process as opposed to an inert substance. But when you have something that you've made that synthetic, it obviously you can have more desirable desirable properties to that product. So I think it's really exciting that down the pipe, there's going to be more material coming out that when I think about like a very, very large deep wound that's not quite ready to be healed, but just needs a bridge to a skin graft. I think that Myriad really can fill that gap once we have a product that has some more layers and as a way to be a little bit stronger to stay in place until we can skin graft the patient.

So just to follow up on that. I don't think we've had any reported adverse events in terms of reaction against the ovine material. So I think it's partly the purification process and just the homology between that material and human proteins. So we're going to wrap that up there and move on to the next section. So thank you, [ Alison. ] I mean I'm really excited to see this publication come out for the trauma study. I think what we're seeing there is something that's very similar in terms of consistency with the [indiscernible] salvage procedure study that we had. So lack of infections, typically healing with single single applications and the rate of tissue repair. So sort of reinforcing the overall messages for Myriad, which we're starting to see kind of universally where this product is used. So [ Allison, ] thank you very much. And yes, I look forward to staying in touch. So we're going to move on now to [ Dr. Jason Brown. ] So Jason is an Australian, he's kind of unusual in a way in that Aroa has not really focused on commercializing our products here in Australia. So we -- we sort of stumbled across Jason at a conference. So he was at a conference where surgeons were talking about Myriad and Jason got [indiscernible] and really off his own bet contacted us and said, "Hey, look, I'd like to try it too at my burn center." So he's based up in Brisbane, and he's a consultant to the acute surgical and trauma services there at [indiscernible]. Director of the Professor [indiscernible] Centre and Royal Brisbane and has extensive experience and burns, but also in trauma. So Jason, welcome and look forward to your presentation.

Thank you. Is it the big green button? See if I can get this wrong. Look, thank you for the opportunity. I guess to set the background, I'm a full-time public servant. I've worked in Queensland Health for 30 years at the end of this year and 20 of those have been spent as a general trauma surgeon at [indiscernible] Brisbane Hospital. I've worked in the burn service there for going on 15 years now, 7 of which have been director. So I can understand Dr. Smith's experience because I think a lot of those same challenges we've shared over the years. And I guess the purpose of this is to give some of my experience around how Myriad is impact and changed how we manage burns in Queensland. So I guess, just as a background, burns is an injury are very common. I would challenge anyone in this room who hasn't dropped a cup of coffee on the lab or picked up a hot pan out of the oven. So thousands of burns happen every day. Luckily, for most of those, they never have to seek medical advice, and I think it is a reflection on how good our skin is, not only protecting us but regenerating. We get about 5,000, 6,000 burns referrals a year to the burn service. Now these are slightly worse burns. But even of those, most of them heal on their own, they may come to clinic, they don't need an admission. So the patients we're talking about are a very small percentage of all burns and they are the ones that have significant skin loss from burns. They need to be admitted to ICU. They would die without any immediate treatment. And then subsequently, they usually die because of infection because 1 of them -- your skin does many things, it's a largest organ of your body. But 1 of the things you realize it does when you've lost a significant amount that keeps the bad outside world away from the very soft inside world that is very susceptible to infection and subsequent death. So in that regard, burns, and I think there was a question from Mark, why isn't there more studies? Burns is a rare disease. So if we Australia-wide admit about 400 patients to ICU with major burns, that's less than 1 in 10,000. The definition of a rare disease is 5 in 10,000. So major burns is a rare disease, which means getting good data around what works and what doesn't is actually really hard. And it takes global alliances of research to gather that data to show trends. And globally, there are very, very, very different approaches to practice. And it is a bit of an artesian kind of approach. I think it's a bit like cooking. There's many ways to cook [indiscernible] and there's many secret recipes at the [indiscernible], but you ask every chef that does it, and it's a different recipe. Burns is a little bit like that. There are a lot of interesting characters in burns. Sorry, I should have given the warning, there are some gross pictures. The other thing in burns, I think we have a skill set. And I guess my skill set is I can cut most of your skin off and still keep your live. But the super power is I have to put that back together because anyone can just cut your skin off. What we're finding more and more is it's not just burns that cause -- we have a skill set that -- we get [indiscernible] when there are big wound problems. And a lot of those wounds are from older population, our pressure areas, [indiscernible] soft tissue infection, which Dr. Smith mentioned. So we had a relatively busy weekend this weekend in Queensland. We had 7 admissions to ICU, 1/4 of them are from [indiscernible] infections, not just burns. So this is a spectrum of skin deficits that we have to address and now infection is becoming a bigger and bigger part of that. So usually good thing about a burn, it's not effective when they come in. Your job is to prevent the infection killing them by putting a temporary coverage on that or as a bridge to getting enough skin because often these patients have 60%, 70% burns and they don't have enough skin to cover them. So you have to create a temporary coverage to stop them dying before you can skin graft them. And this is where some of the tools that we use, really, what is the difference between surviving and not surviving an injury. So we have a whole series of tools we use. We have synthetic scaffolds, biologic scaffolds, allograft, which we have -- we're lucky to have a tissue bank in Queensland that has human-derived tissues, whether it's heart valves, [indiscernible], bone, skin is 1 of their main other tissues. So I guess what I try and do -- and I mean the reason I went to the conference, I try and go to at least 1 or 2 American, European conferences. My trick is to stay 1 step ahead and to be on the edge of using what we know will work on patients, especially Europeans, Americans have very different approaches. So always trying to look at what's the next thing. And then 1 of the problems we had was tissue banks were struggling to keep up with the demand for allograft. So an allograft is essentially -- well, there's 3 types of grafts. There's homograft, which is our own, which is really what we're trying to cover your wins with longer term. Allograft means it comes from the same species with someone else. So the from organ donors. And in Queensland, like I said, we have a tissue bank. They procure the tissues. They have a whole process around screening patients and organ donors. Obviously, they have to get out to the facilities where the patient dies within so many hours. So there's a whole team that do the procurement of the tissues. There's a whole screening process around commutable diseases, then that tissue is processed, and we have fresh frozen allograft. So once it's processed, it's stored at minus 80 degrees. So 1 of our challenges is that cold chain there has to be a whole tissue tracking to make sure there's no diseases that have picked up to make sure we close the loop on the quality. As I said, the supply was tricky. Now when we look at dollars and dollars are really important in a public service, the dollars between allograft and Myriad aren't that different. But I can tell you, processing allograft, where you've got to defrost it, you've got to then put it on the table, you have to measure it like a skin graft, you have to prepare it. Each sheet we use could take 5 to 10 minutes, whereas Myriad is basically open the packet, put [indiscernible] on, it's ready to go. Now that's important because I think operating costs on average cost about $2,500 to $3,000 an hour. So every minute you save, that's $50. And when the difference is between 1 minute per sheet versus 5 to 10 minutes per sheet, that's a lot of time in the operating theater and a lot of money and a lot of dollars saved, which aren't always cashable immediately. So certainly, 1 of the biggest things is it's simplicity to use. It's kept on the shelf. I don't have to keep it in the minus 83. So I don't have to make sure the stocks turned over, and we're using the right piece or it's not the frosting of the freezer isn't going down because the uninterrupted power supply has gone out or there's been a thunderstorm. So from that regard, it's so much less stressful. So the question is, could Myriad Matrix replace the use of allograft equivalent. So about 1.5 years, as Brian mentioned, I was at a Burns conference. As I do, I look at the products, and this was the question I had, what can I use to replace allograft. Because I'm having struggles. It's probably not the easiest tissue. There were some really good presentations on a number of other things, but I was quite impressed with Myriad. And usually, my challenge is Australia is a small addressable market in terms of burns. And usually, I go around checking the [indiscernible] listing and most of them aren't listed. And there's often a conversation, which is, would you bring this in? And is when I went to the Aroa stand, [indiscernible] surprised, this was a listed product I never heard of it. So I ask the guys there and they linked me in with some of the Aroa guys in New Zealand, and I just had a call with them and I said, "Hey, how do I get this? I need to try it out." And they were very, very accommodating in terms of yet where you're based, will send you out some samples. So when we talk about training to use the product, I had 0 training. Having said that, I've used many, many products over the years. done many first-in-human trials done the validation trials for other products. So probably in that regard, we've got enough experience to work it through. And we started small on different use cases where we use allograft, whether it's a wound that was going to heal on sensitive areas, whether it was a difficult infected wound and [indiscernible] soft tissue infection, whether it's as a sandwich graft because obviously, when you've got very little of their own donor skin, you want to stretch out the graphs like fish net and often we put a sandwich graft over the top of that to help protect the skin graft so we can grow in under it. So every single use case of allograft that we use Myriad on, it was performed as well, if not better than allografted. So I can say, hand on heart, we haven't used allograft for over 12 months now. Having said that, it was a little bit of an opportune time because there was a fire at the tissue banks in earlier this year, and they haven't been able to supply us with allograft for 9 months. So if it wasn't for this [indiscernible] fine, we would have been a whole world of pain in terms of temporary coverage for Burns patients. But having said that, I think it's worked out quite well. quick presentation, but I think it's sort of echoed a lot of what Dr. Smith said, but in a very specific use case for burns.

Could you just talk through the alternatives and synthetics, something like [indiscernible] how that would work as the networks at case?

So yes, we use a lot of [indiscernible] BTM. As I said, we were part of the validation trial back in 2017 when it first came out to Australia. BTM has a very specific use case. So I've had cases where I've used BTM over Myriad. So BTM needs a very healthy, clean, vascularized tissue bed, and it's a dermal substitute. So it will create a neodermis. Without that, it fails measurably. But everything you put on needs of vascular bed. Myriad, you can put on to a compromise wound, whether that's contaminated or on structures that aren't well [indiscernible] and tendon and it will stimulate that vascularization. You can then, if you want move on to a BTM type, and we do at times. Otherwise, some of these wounds that are really compromised. You just want to get them closed and get the patient out the door before they don't make it. So you're not worried about scar and function. You worried about wound closure before they die of something. So Myriad is really affected there. So we use both tools. I don't think 1 replaces the other. And if you think 1 is in competition other than you don't quite understand where Myriad's strengths play to and BTM strengths play to.

One about for aesthetic outcomes, how does it stack up on that [indiscernible]

Look, I think the main thing is not so much how good the scale looks at how [indiscernible] functional it is. And I think that's a tricky question because I think when you use a product that gives you some coverage over vital structures like [indiscernible] and bone. It does give you a better functional outcome because they need to glide if you have a hand or an ankle where you've got your Achilles tendon exposed, anything you put over it that allows it to guide. So my experience is Myriad can provide that. Historically, we would usually use a BTM or [ Integra ] type dermal template as a secondary because you need to build up the tissue. And the contraction in scar that comes down the track historically been less. But this is an area of no evidence. Every product, including BTM and even [ Integra ], over 30, 40 years of [indiscernible] there is not a lot of evidence to say it gives a better scar outcome in skin grafting alone. Even though anecdotally, and I'll tell you my experience, it does. So I've got dozens of cases of [ Integra ] and BTM over the last 20 years where the scale is better. Myriad, I think I probably haven't got enough experience to say that, whereas Myriad versus nothing or just a skin graft does it give a better scar, I'm not sure. But experience would suggest anything that builds up a neodermis, even though Myriad's not claiming to be a dermal reconstructive template that it is a biologic scaffold will give you a better scare outcome.

Just curious given the circumstances of your use of Myriad, given the -- maybe the lack of allograft available at the time. Going forward, how do you see that being used?

So I think allograft usage, we would use, and it varies on -- burns is a bit cyclical. Like I said after last weekend, they had to have a call and said, look, we need another 100 units to get these 7 patients through. We would, on average, use 500, 600 units of allograft a year. Myriad would replace all of those. Like I said, I haven't used allograft in 12 months, so the tissue banks can focus on other tissues. And I can't see where I would use it unless I couldn't get Myriad Matrix. But there's probably more sheep than human donors available.

So with allograft, sort about large service area [indiscernible] are you using allograft on 100% of those burdens. I mean is that part of the staging of the reconstruction? Or what sort of percentage of those cases?

Yes. I think any burn over 30%, 40%, you start to reach a limit of your donor site. So you need to take your donor sites more than once to cover that burn. So somewhere along the line, you've got to temporize their wounds to facilitate that. That temporizing membrane could be [ PolyNovo, ] which gives you a longer-term temporization for several weeks or it could be Myriad. I think the challenge is often while that -- in that temporization process, you always get some amount of infection somewhere. And that when you get infection, your salvage option is usually allograft or another biologic because biologics are much more resistant infection and Myriad's proved that. So I think every burn over 30% to 40%, we would use Myriad somewhere in that, whether it was a temporization bridge or whether it was a secondary layer over a very widely mesh skin graft. We've also are lucky enough to have our own skin culture lab, so we actually grow patient skin for those patients as well. And we've used Myriad in combination with cultured [indiscernible] sheets, and it's worked really well as well. So cultured seats, they're not a replacement for skin graft. They're very finicky about how well they take for many reasons, and we're trying to develop food research better way to do that. But what we find is when you put them on either a well-prepared wound bed, you can get a much better take when you combine it with a widely mesh skin graft of [indiscernible] on your patient skin and get a better outcome with that. So we're lucky enough to have a dedicated lab and to also add that to a toolbox of approaches for patients with significant burn wounds and skin loss.

Yes. Just 1 more for me. Are you the sole user of the product at your hospital? And how would you consider the adoption rate amongst your peers? .

So look, I'm in a good position that I'm the director and my peers do what I tell them to do. So we have 6 surgeons on staff in the burn service, and we -- we work as a team turns the team's port, and we all follow the same model of care, and we don't have patients under our bed card if you're admitted to the burn service you're under the team. So yesterday, we had 4 surgeons working on 2 patients all at the same time, and there wasn't any fighting. So we all take the same approach. So within the burn service, we all do the same thing. So there isn't a problem. Now -- there's a few other units that will do their own thing. And eventually, it might take them 4 or 5 years, but they will eventually come around to realize that, yes, what we were doing is probably the best thing when it comes to skin coverage.

What about it in the rest of the state.

So we're the only adult burn service for the state. So the only other one, the children's is separate. And now the children's are a little bit of a different [indiscernible] fish. And I think there's been several other centers around Australia that have reached out recently going, hey, I've heard Brisbane is using this is can we have a chat and I'm how was open to people giving me a call. But they're not my problem. My only problem is Queensland and the adult burns that we treat. So whatever it's doing best for them, if anyone wants to get on board [indiscernible] open, they did the door and happy to share my experience with them.

What about other biologics, if you use other biologics? Or are they just too cost [indiscernible]

No. We have several other biologics. We is [ Matador, ] which is a biologic dermal template. Like said, we've used [ Integra ]. The other biologics, there aren't a lot of availability in Australia. So there used to be a poor sign derived one, which I don't even think they make anymore, which we had used a number of years ago. But our primary biologic was allograft. I mean that's the gold standard. If you don't have your own skin allograft is a gold standard. If you can afford it, it can be expensive because of the processing. But the fact that Myriad has replaced the gold standard temporization biologic, in my view, it speaks for what it can achieve.

Just to clarify, do you only use the sheet? Or do you use the morsels and the sheet?

Look, we do the MacGyver approach to these things. So I've [indiscernible] the sheet. I just use the sheet. I have 1 product on the shelf. But if I need to packet cavity, I'll just slip it up into little pieces. If I need 1 layer out of the 3 layers, I'll separate it to 1 layer because I think it will -- on a dermal superficial burn, I don't need 3 layers, I'm not building up tissue. So it's nice to have it preprepared, but I like to keep supply chain and stock side. So just give me 1 thing, and I'll just make it work.

Why don't you go back to comments in round different like you've talked about burns, but different considerations and things like in STIs, do you see any difference or same general principles. What is it in those sorts of things that Myriad [indiscernible]

Yes. Look, I think -- what we're seeing and the rise of soft [indiscernible] soft tissue infections is people are living longer. We're a victim of our own success in medicine where keep people alive longer, and we're seeing patients who are significantly immunosuppressed, have diabetes, have organ transplants, have had their second cancer and they're going through their second round of radiation chemo. These patients don't have a functioning normal healing process. And I think they burn patients are kind of the biggest cohort is males between the age of 16 and 40. I always say we deal in stupidity and there's no vaccine for stupidity. So business is good. When it comes to necrotizing soft tissue infections, this is where the -- you're dealing with a compromised patient. They're already a challenge. They're already dying of their bone marrow failure, their kidney failure. There are other endocrine failure from diabetes. So to get anything to work in these guys is really tough. If you try and salvage a limb significantly impaired obese diabetic patient who's got an [indiscernible] soft tissue infection, it is not easy. And you need to pull out everything you can to try and get that limb salvaged and get that person out of hospital as quick as you can. Because unfortunately, the reality is we will cost the most of the health care system in the last few months of our life. So the less you can reduce them, the more you can reduce that burden, the more we can make health care more affordable. So I've been impressed because there have been a number of patients that these were unsalvageable as far as I was concerned, and we've used Myriad, and I've been surprised by how well it has worked and it's got these people out the door with their limbs still attached to them. So like I said, I deal in things that work. And if something works, it's cost effective because it gets the job done and get people out of the hospital and gets them back. And Myriad is 1 of those things.

What do you think is the biggest hurdle to Myriad being more widely adopted for Barnes?

The biggest hurdle. Stubbornness and the fact that most of the burn centers are run by plastic surgeons, they are a little bit more ingrained in what they do and not open to change. As soon as I don't want to change my practice, I need to retire, I think surgeons scalpel blades get blunt at a certain age. I might be getting close to that, but you need to step aside when that happens. And I was interested in the OviTex talk because I used to do a lot of complex abdominal [indiscernible] constructions and their comments around the younger generation coming through is very true. We do get set in our ways and we stop changing and adopting new things, even though they may be better. It's like old dog new tricks. And I think when that happens, I would not be a director anymore.

[indiscernible] comment I'd make on that is that burns hasn't really been a focus for -- and in a way, we've been pulled into it probably over the last 12 to 18 months. So what we've seen in a number of centers in the U.S. surgeons beginning to use Myriad [indiscernible] procedures. So particularly over the last 6 months, we've really seen sales start to grow. We have a couple of leading burn centers now in the U.S. doing studies and evaluations on the use of Myriad [indiscernible]. We've recently launched a mesh version of the Merian product as well, more specifically -- so I think it's an area where we will see increasing success.

You mentioned the fire of the tissue bank, which kind of gave this opportunity, [indiscernible] say when the tissue bank comes back that you'd move back to allografts or there be any pressure to move back to them we think permanently, right?

No, look, I think the fire just happened to reinforce that having it back up because we -- ideally for disaster management and we've been through a few disasters over the last 15 years, we would keep 200 to 500 graphs in the freezer as a backup because we could have 10 burn get a burn center can get very quickly overwhelmed. I went to [ White Island ] in New Zealand to help out and they were getting imported allograft from the U.S. because they couldn't get enough of it. And luckily, that's a big market. They can absorb some of that demand, whereas in Queensland. -- even when we've had to go to Sydney or Victoria to get some of their allograft, they couldn't supply it either. So we've had to try and produce our own at a level that would meet the demand. And I would always -- for the last 5 years, 6 years, I've been trying to get that 200 to 500 graft buffer, and it just has been impossible. So that's why I had been actively looking for alternatives to -- because if we don't have [indiscernible], people die in our model of care because you need something biologic to temporary some of these really difficult wounds. And like I said, Myriad's performed equivalent, if not better, in some cases, and surprisingly so then [indiscernible]. So as long as I've got a stock a Myriad, I can't see why I would go back to using our [indiscernible], it's just more difficult and takes longer and it's deadlier.

Just 1 more question for me. You said that you can use Myriad in the vast majority of cases where you were previously used an allograft, what about in those really deep wounds or a reputation where you're trying to seal off the wound. Can you use an allograft in that?

Well, really because allografts epithelialized, so if I put allograft in there, it'll actually stop the tissue sticking together because it's got an epithelium layer. It's not just dermal. So you have a process decellularized dermal substitute. I can't remember [indiscernible] derm or something else like that, which is human derived was allograft is fresh frozen. It's got an epidermis, which stops things sticking and it also you'll get eventually an immune react response that will reject those cells because it's not decellularized. Whereas Myriad being [indiscernible] and just a collagen matrix that supports tissue kind of regeneration and that granulation tissue that helps wound stick together, that is an area where you couldn't use other graphs before, and I haven't used it for that use case, yes.

Do you think the science is really well understood internationally. I mean you're clearly across it, but doesn't appear that other people have got the message in.

I mean the site is [indiscernible]. There's so many -- there's fish substitutes. Brazil will have a whole tilapia fish tissue bank that they use fresh frozen fish, there's porcine, bovine, ovine. So the actual signs behind a biologic matrix isn't new. It's really getting the product at a price point and with an effectiveness that proves value. So I'm not saying any of these other bovine-derived or [indiscernible] xenograft type matrices were not equivalent or as good as, but certainly, the market is flooded with them. But it's really the successes in one, is it a good product? Does it work? And two, does it demonstrate value, especially in the public sector. And I think those 2 boxes definitely a tick for Myriad.

Okay. So I think we're probably come to the end of the question -- so Jason, thank you very much. Super interesting talk. And we're really pleased that you gave us a call and got started using this here in Australia. So -- what we're going to do now is wrap up the online sort of investor presentation session, and we're going to have a short break. After the break, we're going to come back and in the room have some table -- roundtable discussion. So the way we're going to run this is 20 minutes at a table, 10 minutes of Q&A, we're going to cover 4 different topics. So we're going to talk about our commercial strategy when we talk about Symphony and the changing reimbursement landscape, talk about Enivo and then also talk about the OviTex portfolio and a chance to discuss this with the Arrow management team. So hopefully, this morning has been interesting. And I think some -- certainly a great group of presenters, hopefully, some new insights and some confidence about what Aroa up to. So let's wrap it up there. There's a cup of coffee outside, and come back in 10 minutes. So we'd like to keep the pace on for the rest of the morning. Thank you.