Just have to look up a little bit, do something a little bit different. What I'm going to do is run through the format books here. We'll start with James and I, presenting the half-year results. They will go into a series of presentations. There will be 20-minute presentations followed by 10 minutes of Q&A. We will start those presentations. When we begin the presentations, we will have live questions. Those live questions, we will take them from the floor first. Most people attending online, you either type the question into the Q&A function or raise your hand when we take the questions live. Please note that this session is being recorded. Following the presentation of the results, we have Tony Koblisch, CEO of Tela Bio, Jeff Blizzard, President, and Jim Hagen attending, talking about progress at Tela Bio. Following that, we will have Dr. Alison Smith.
She'll be joining us online. She's a surgeon that's been running a trauma study for us. Then we'll have Dr. Jason Brown, who's attending in person, and he'll be talking about his experience with Myriad Matrix. At approximately 10:40, we'll break. The live event will conclude, and we'll then move to some roundtable discussions on some key aspects of the business. We'll conclude the agenda at 12:30 this morning. With that, I'm going to pass it over to James to take us through the financials for the first half of the year.
Yeah, I'm ready.
Let's go through this. Morning, everyone. I'm just going to give a quick overview of the financial results for the half-year of the financial year 2026. Look, starting with revenue, revenue was $44.9 million, was up 13% on H1 in 2025. Shortly, I'll sort of take a deeper dive into revenue in terms of how it was made up. If we look at gross margin, gross margin was 85%, was down 2% on the current period. However, it was in line with the previous half.
I wish that is going to the—
We're going to be—
Yeah.
At the start of the period, however, these increases were a slight increase in the higher margin material sales. If we look at normalized operating expenses, AUD 39.6 million for the half, only increased AUD 1 million, 3% from the prior year. Breaking that up, selling and admin expenses were AUD 35.5 million, increasing 7%. This included clinical development costs of AUD 2.6 million, decreasing from AUD 4.3 million in H1 2025. The key reason for that was this last year, we had a large investment of costs incurred for the Symphony RCT, but also as a result of some of the timing of the clinical activities that we had planned for this year. If we look at the remaining of the sales and marketing expenses, sales and marketing expenses were AUD 23.6 million, increasing 13% or AUD 2.8 million.
This was primarily reflecting higher variable compensation for the sales team, but also the inclusion this year of U.S. tariffs, which were up $0.8 million. Turning to R&D, R&D was $4.1 million, decreasing 52% compared to the previous corresponding period, $1.3 million, but in line with the prior half. Ending the half year with a normalized EBITDA profit of $1.8 million versus a loss in the previous corresponding period of $1.5 million. Turning to cash flows, cash from operations was $4 million, compared to a net cash outflow of just under $5 million in the previous corresponding period. Cash receipts were $45 million compared to $38 million, primarily as a result of increased product sales, but we also saw a lot more effective management and trade deals. Cash payments, $41 million, decreased from $43 million in the previous corresponding period.
Turning to investing activities, investing activities were AUD 1.6 million compared to AUD 2.2 million, primarily reflecting lower capital expenditure. Financing was pretty much in line with the previous corresponding period at AUD 0.9 million. The group then, as a result of this, reported a second consecutive half of positive total cash flow, which is a significant milestone for the company. Generated AUD 1.5 million, ending the half year with AUD 23.4 million in total cash. Obviously, the company remains debt free. If we look at sales, product sales are AUD 44.6 million, increased 14% compared to the prior year. If we look at the sort of makeup of direct sales, Aroa direct sales contributed to 57% of the sales mix. This increased from 53% for both the last two halves, so that is H1 FY2025 and H2 FY2025.
If we look at the individual breakdown, Endoform remained relatively flat, contributing NZD 5.7 million. Myriad's revenue increased 33% to NZD 19.7 million. Revenue to Tela Bio increased 4% to NZD 19.4 million. It is important to note that whilst we grew 4%, Tela Bio's revenue for the same period increased 16%. The variance in that is because last year there was higher sales of these lower turnover SKUs, so it is nearly a timing difference. If we look at our sales metrics for Myriad, we continue to grow the base of customers, increasing from 328 to 380, 16%. That is from the end of March 2023 to September. We also continue to increase penetration of accounts, increasing from just under 100 to NZD 110 million.
If we look at sort of, again, our sales force, as a result of increasing sales and maintaining sales force, which are 52 persons, obviously we continue to increase that level of sales productivity. With that, I'm going to hand it back to Brock.
It's been quite a quick year for a Director of our strategy to say that we're sort of clear about what we're trying to do. As people know, we're really focused on soft tissue reconstruction, and 95% of our sales are in the US. We've sort of seen this in two parts. There's the Aroa direct part and the Tela Bio part. For Aroa direct, we've really been focused on our Myriad business. Myriad business is an inpatient business, acute surgery, predominantly in trauma and lower limb reconstruction. There's an outpatient component to our business, so that's been predominantly our Endoform business. James spoke about that. It's been relatively flat. It's a high volume, relatively low value product, but it's given us a presence in the outpatient wound surgery and treating chronic wounds like diabetic ulcers and venous ulcers.
It's been really important for us to keep that footprint because we've had simply progressing through the reimbursement process and the fee. I'll talk a little bit about that later. Aroa focused on inpatient, but also positioning itself to take advantage of some changes in the outpatient setting as well. For Tela Bio, we've been predominantly focused on hernia. We've built our fantastic portfolio to cover all of the range of types of hernia. There's quite a diverse mix there. Tony and the team will talk a little bit about that. Also focused on soft tissue reconstruction in breast post-conceitement. Together, that's probably in excess of $1.3 billion in the US. We're pretty much a US-focused company from a sales and marketing perspective. Own pipes and sales come from the international. That is changing.
We'll talk a little bit about that in sessions later today. This is sort of how we see the focus for the Aroa direct team. If you think about inpatient procedures for Myriad, 75% of those procedures are in trauma. They're trauma-related procedures. They tend to be cases that are very high value, but don't happen every day. It's a very—sorry, it's 50% of procedures are in trauma. That's a very important segment within this market. 25% of the procedures are in lower limb reconstruction, lower limb salvage. We have to succeed in trauma, and we've got to succeed in lower limb salvage to be a major player in the inpatient setting. That is another 25% of procedures that are a massive wide range of other things that are important. Particularly important if we look for one standard of care within a hospital.
We are very focused on succeeding in trauma, succeeding in lower limb salvage, and then showing that we have utility for hospitals across a wide range of other procedures. We are sort of positioning ourselves to be able to take advantage of the opportunity in the outpatient setting. We will be using our existing sales team to begin that process. We are also looking to establish a new sales team in the outpatient setting. We will talk a little bit about that later. The other initiative we have underway is that we have seen great impact using Myriad in combination with neonatal children's therapy. That has driven us to undertake an RCT to investigate the difference that that combination can make compared to using neonatal children's therapy alone. We are in the process of initiating that RCT and getting it up and running.
We think we're going to be able to demonstrate really meaningful differences there. The importance of that is that is a very large market segment. Needle pressure is one of the most predominant techniques used in wound care. If we can combine our technology with needle pressure wound care, we think there's a very good opportunity there. Just in terms of operations, I think everyone's familiar with the company. The Aroa direct team, the Tela Bio team, large market opportunity. We've got quite space in Aroa ECM. The technologies that I've established will be very similar to the building out evidence for the technology. We've got a great body of evidence around these things, and we'll continue to build on that. Why do we make a difference for hospitals? Why do people use our products? I think there's two parts to this.
One part's clinical, and we can deliver clear clinical evidence for fertility. That is the rate at which we can restore tissue, the fact that we have fewer complications with using that technology, low rates of infection. Typically, we do not have problems with graft loss, so you do not see projectious material. Lastly, those things lead to higher satisfaction for patients and higher satisfaction for surgeons. On the other side of the hospital, we can lower the direct cost of the product. Typically, our product is priced at a small discount to the market-leading products. What we find is that you do not need to use the product so frequently. Often in these tissue generation applications, they are applying the technology two, three, four, five times for the same outcome.
What we're seeing with Myriad is that in many cases, a single application is sufficient to get very good copy replay. And what that means is that you can get the patient healed quicker. You don't need to use up resources at the hospital. You can get the patient out quicker, and that's increasingly anonymous for the hospital. Just quickly, in terms of each of the different products. I think Myriad has made some great progress, James. As James said, sales were only strong with Myriad. We think Myriad is a huge opportunity in the fund. We see this as being a technology that can be standardized within hospitals, most soft tissue reconstruction. We've recently launched a mesh version of Myriad following the use of Myriad in burns. We've seen some success in that area. I think that'll be an area where we see increasing growth.
Certainly, we're seeing some changes now being proposed for next year with something which sets up a very favorable environment. If those changes hold, and we have seen CMS pull back from years previously, or there is potentially a risk of some political changes coming down the line. If those changes hold, Symphony is very well positioned to succeed really well. We also see the combination of both Endoform and Symphony being very confidential in the outpatient setting. For OviTex, the OviTex continues to grow. I think we've got a very comprehensive portfolio there. I'm sure Tony will talk about that. The clinical data is compelling. I think we'll continue to see strong traction with OviTex. We think that's an incredibly valuable asset, and we'll continue to grow. Just in terms of outlook, we're reopening our guidance.
Very confident in terms of where we're sitting for the full year. We'll be at guidance with $92 million-$100 million, normalized at $5 billion. In terms of key milestones for us this year, we were really focused on making some good progress in trauma and lower limb salvage. We're on track for that. Really clarifying our value proposition for hospitals. We're going to take the economic benefits of using Myriad to hospitals. We've got a lot of good data coming through on that now. The sales team is really not about getting more accounts. It's about being more successful within those existing accounts and expanding through more users in the accounts and more specialties within the accounts. Our fastest sales, we're focused very much on how do we lift our rent.
A lot of that is how we manage the sales team, how we manage training, which accounts we target. I think we're making good progress on that. Generally, we're heading in a good direction in terms of those improvements in sales productivity. In terms of milestones, focused on demonstrating various sustainable value. We've had to work really hard to try and convert one IDN system within the US. That's still a work in progress. Securing reimbursement for Symphony in the physician's office, and that's in terms of the completion of our Symphony RCT. That's on the road. I think we'll complete at the end of November, and then we'll be into looking at the data and publication. That's very much on track. I'm going to conclude there and open it up for questions.
Just on that IBM you mentioned, can you just, I guess, tell us about how that process has been? Where are you kind of original backseating there? I see that the idea is if you lock in and sort of on the platform strategy.
Yeah. Yeah. The question from listening is with the IBM strategy, how's that work? What are we trying to do and how are we sort of bringing that to life? As we've become more successful in individual hospitals, most hospitals are part of large hospital networks where a corporate owns multiple hospitals. Our strategy has been firstly to demonstrate success in an individual hospital. Within those hospitals, develop some advocates that can then promote the benefits to the wider hospital system. We've had that from a clinical perspective. At the same time, we've done a lot of work generating the economic evidence to show to the hospital that, for example, if you can reduce the number of infections, if you can reduce the rates of application, what does that mean in terms of the economic impacts for the hospital?
We have built out a clinical story and an economic story. We are now taking that economic story to the hospital and saying, "If you can see this in one hospital, what would it mean if you can see it in three hospitals?" That is millions of dollars a year. That is something where you are going to get great clinical outcomes, but you are also going to improve the economics for the hospital. We have been sort of looked across the whole growth of the company. We have looked at there are some particular IDNs that stand out as being very focused on profitability of those IDNs. Then looking at, can we work at a regional level? Can we work at a national level? Put in place an agreement that locks in volume, locks in terms of purchase.
I have to say we've worked on this for quite a slow process. They move quite slowly, but it's a massive opportunity. The great thing about it is that it locks in large volume and certainty. It means that your sales team aren't chasing around for a bigger case, but they actually have a lot of strong basic beliefs.
Hi. Sorry, Brian. Shane.
Oh, Shane.
I had a question on the RCT. Just see the data. The second one would be successful with all consensus changes. I think they've put it actually.
Yeah, I guess so. In terms of the study, it's 120 patients, DLQ study looking at emergency closure. There's a standard that we're essentially running, a very standard protocol that's been running across a wide range of products. We know that it's a protocol that's been accepted by CMS previously. That's on training. That'll include everything we will get in terms of analysis. We need to analyze the data and the data being used to publish. They're more to take into seriousness than we publish. That process is a little bit unclear at the moment. We put in some additional data into the processing, saying that we're a full data pack that will come along shortly when we publish.
Potentially as a placeholder in the process, CMS hasn't provided any updates in terms of what that process can look like at the time. Also, there had been an ad hoc process where once those have concluded, companies have been able to take that data to the next and get reimbursement as well. We're going to run both of those options in our line. In terms of the changes, CMS put out a draft in May about the changes that have been made. In November, they came back and confirmed those changes. The changes are that we're going to go from paying for products at 6% of ASP, which is very popular to the environment where essentially physicians were buying products at 6% of the product and need to capitalize on the reimbursement. That's going away. The price has been capped at $127 a square centimeter.
From a CMS perspective, it looks like this a lot. We're very aware that the incumbent companies are very much against the change. It's political volume to all of that or to supersede it with another bill. It's a bill that's in America being put forward to try and usurp it. That may or may not happen in terms of it's onto the list before the end of the semester. Our kind of our sort of thinking on this is that we're assuming that it's going to go through, but we're prepared for this change of funds at the last minute. I think when you look at CMS that want to make this change for a long time, they've seen that the system's not working. There's been action.
There's been commentary out of the hospitals, in general, over the years saying that there's a lot of abuse in this space. We kind of think the seeds prevailed. It'll go through. On 1st of January, we'll be in a position where the rate is. And at that level.
We think that a lot of the companies that have been in this market, their business models won't be sustainable after the 1st of January. We think the landscape could change dramatically and favorably for Aroa. We think Aroa could be in a very good position if this changes after the 1st of January.
Thinking about all the varied sort of sites of service that that brings into play, particularly physician's office, I mean, how are you thinking about operationalizing that?
Yeah. A couple of ways. Our existing team, we're focused on lower limb salvage in the inpatient setting. Our existing team will have relationships with surgeons that do procedures in their physician's office. I think that links there for some of our team. We're not calling on physician's offices and LTACs and these other sites of care. I think in order to succeed there, we really need to look at some other sales channels. Our strategy is that we will be prepared to set up a contracted sales team on a commission-only basis from the 1st of January.
Our thesis is that there's a bunch of people that after the 1st of January that have previously been working in companies that were viable at the higher levels of reimbursement, there may be a pool of people out there looking for their next option. What we'd like to do is capitalize on that and bring them on board as 1099s or as contracted salespeople.
Yeah. I would have thought that the 99s were the bulk of the Wild West.
Yeah. They are. Yeah, they are. I think there's two groups. There's 1099s that have been working in this environment over the last four or five years that have been on a commission-only, doing some inpatient stuff, doing some outpatient stuff. 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, that's the economics aren't going to work going forward. I think for us, they'll have established relationships with physicians, with outpatient wound centers hat we'd like to do is target that group to get them up and running. That may take us, that's probably if this comes into place on 1st of January, I think everyone's kind of holding their breath to see what happens.
I think there'll be a little bit of chaos post the 1st of January. It could take us three to six months to kind of get that in place. We think that you sort of go from sort of zero to something where you need quite a large degree of coverage. That seems like the most obvious option.
Thanks, Brian.
Great. That's 9:00, first half hour. What we're going to do now is change it up, and we're going to have some presentations. We're going to start off with an update from Tela Bio. On the line, we have Tony Koblisch, CEO of Tela Bio. We also have Jim Hagan, who's joined Tela Bio recently. Jim is the Senior Vice President of Strategic and Commercial Operations and Marketing at Tela Bio. He was previously a General Manager at Acelllity, where he led strategy, product innovation, and business development. We also have Jeff Blizzard on the line as well. Jeff has been President since June 2025. He served on the Tela Bio Board of Directors for a year until he joined as President. Prior to this role, Jeff was Global Head of Surgical Sales at Acelllity, which was a Johnson & Johnson company.
Between Tony, Jeff, and Jim, we've got a team here of very experienced medical device executives. They're going to provide an update on how Tela Bio's tracking. Tony, I'm going to pass it over to you.
Thank you, Brian. Good morning, everybody. We 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. Please feel free to ask the three of us anything you would like. I'll just add a little bit to Jeff and Jim's bio, not to speak for them. ABO Med arguably is one of the most successful med tech companies in history in terms of consecutive quarterly sales growth and overall volume of growth. In the latter stages of that company before it got sold to J& J, it was really driven by the surgical division. When Jeff and Jim came into that division, there was very small revenue at the surgical division, maybe $15 million or so. Today it's around $500 million.
Part of the rationale for upgrading our leadership team on the commercial side is to move beyond the startup phase and the development stage. That has had some nice results for us. It has yielded an $80-plus million business as of this year. We want to hand the reins to them and figure out how to build this company to first a $100 million business, then 200, 300, and maybe even up to $500 million. I think the product range that we have today that is commercial, if you look at the proxy companies, whether it is Bard or Lifecell or some others, can definitely support that level of sales. 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 2026 with Aroa and 2027 and beyond.
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. I do think the best is still ahead of us. Next slide, please. We can just flip through this couple of starter slides here as I get into it. Forward-looking statements. Next slide. All right. You know our story, I think. 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. We are a preservation and restoration company.
We think of ourselves as a soft tissue preservation and restoration company focused on hernia and breast reconstruction. Our goal here really is to eliminate or minimize the usage of first-generation products and materials. That would be in hernia polypropylene mesh, which, in my view, has to go. 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. It is certainly supported by data. On the breast reconstruction side, first-generation cadaver skin is definitely something that we can move beyond. There is a lot of interest in alternative materials. Again, our solution with PRS and our reinforced tissue matrix is absolutely the way to go.
If you look at just some of the metrics, 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. 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 Gen1 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. 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 2026 and certainly into 2027.
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. We have well over 2,500 patients in ongoing, currently active post-market clinical studies. We're lining up to start enrolling our IDE for breast recon. The 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. We have most of the hospital systems either in GPO contracts or IDN contracts. One 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. 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. By every dimension, almost, we've been very intentional about setting the company up to get beyond that $200 million sales threshold. 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.
She is already in their first board meeting, giving 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. That is really critical. We have also brought in Bill Plovnic, who has a very storied track record and history as a medical device analyst and also has been a CFO and a CEO at a publicly traded medical device company. He has a very interesting background spanning both management operations as well as he is 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 salesforce, 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 dollar 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. The two knocks on Tela Bio have been capital raising, burn, and getting that consistent growth up into the right. Consistent sales growth up into the right. We have a plan. We're going to start 2026 off strong. I won't steal Jeff and Jim's thunder. The balance sheet is something that we fix. Our metrics have been getting better and better, quietly, I would say.
Our cash consumption, our burn at the start of this year per quarter was around $10 million. 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 US, very high quality to upsize our debt, replace our mid-cap debt. That is a $40 million debt facility. Now we have an upfront drawdown, which is already done of $60 million, 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. That is another $10 million. Our largest shareholders, not H.I.G. Capital and Essex Woodlands, have really bought into this strengthening plan, and they wanted to show support.
We opened up a small equity raise of about $13 million that was led by our largest shareholders that top up our balance sheet. 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. 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. 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%. It's been steadily coming down to the point where Q3 it was a little over 70%. We expect that metric to continue to get better and better.
I think we've got a permanent solution to the balance sheet, and I think we're on our way in many ways. I'll start from left to right. This is sort of just the simple algebra of sales growth for US med tech. Five factors that add up to growth. One is Salesforce size. Right now, we have historically been behind in our Salesforce hiring plan. Our goal in 2025 was to have about 76 reps on board by Q2. That did not happen. We had three regions or so that were just poorly led and struggled with good hiring. Right now, I'm happy to say that we are at 76 and maybe even closer to 78 reps right now. Jeff and Jim have been doing their job very well in getting high-quality Salesforce reps to build out.
We are going to keep building with a goal of having 90-95 reps, hopefully by the end of Q1 or early Q2, somewhere in there. We are going to continue to strengthen with quality and scale. Rep productivity has been very good for us if you look at the cohort of reps that have been on board with this company for more than six months. With our Q3 metrics, most recently, if you look at the 52 territory managers that we had on board for a minimum of six 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. We definitely can build million-dollar reps, which means we can build million-five and then $2 million reps on average.
We have the track record and the ability to do that. Most importantly, that cohort of reps was at our internal quota plan, which is quite a bit higher than external numbers. The performance with tenure, with quality is there. The shortfall that we had this year was all centered on these three regions that were just struggling and not led well, which those leaders have been upgraded. All the shortfall has either been in vacant territories or territories that were hired poorly and churned. 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 do not want to stop there.
Our goal is to have the best product portfolio that is not based on Gen1 biomaterials, so not based on polypropylene, not based on cadaver skin in the business. There is a very significant launch that is coming up here in the first half of 2026, which is very important to Aroa, and I am sure its investors. We have a long-term resorbable hernia portfolio, which we are going to start to do some early cases by the end of this year. Hopefully, with a full presentation to our national sales force at the national sales meeting at the end of January, we are looking at a first-half launch. That is going to double our hernia portfolio, essentially. Every product that we have that is reinforced with permanent polymer is going to be reinforced with PLGA, which is a long-term resorbable polymer. It is a six to nine-month polymer.
It's the same polymer that has a great track record in our PRS platform right now. We think that that's going to give us a tremendous matchup with Bard's Phasix product, and it's going to be a very important product for us. There are some other products that are coming. In 2027, 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. Hopefully that's a 2027 product that's still in development, and we still have to file 510(k)s on that, but we very much look forward to that. We're getting very close to a lot of the key opinion leaders, the popes, if you will, in PRS land and hernia.
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. There's a nice little range of products that we can co-develop with Aroa that we'll continue to roll out there. I will say that these new products have been a godsend for us and I think have been very good for Aroa as well. There's always a launch build, a bed in, which is good for Aroa. 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 two quarters for two SKUs, right?
There is a lot of productivity that we can get out of this product development process. I think it does leverage the strength of both companies. I think both companies together are stronger than one company could be on its own because of expertise. Our GPO contracting is just excellent. The only national one we do not have yet is Vizient. We have a subdivision called Aptitude already lined up and approved. Whenever Vizient gets around to putting out for bid, I think we will be in good shape there. Lastly, our clinical data is just excellent. I know we have talked a lot about that. I will not go through all the details on that, but we have best-in-class clinical data that supports both products. I will say on the PRS side, we did not have much clinical data until really this year.
We have well over 500 patients in different studies to add to the great clinical data that we already had in hernia. The next slide, please. Growth has been good. We think Jeff and Jim and this new professionalization and strengthening of our Salesforce can accelerate growth from here. I think our gross margins are going to be pretty steady. Target is to get around 70%. There are ups and downs in there based on accounting issues and things like that. For the most part, I think we can rely on a 70% margin roughly. We believe we can re-accelerate growth as we scale and strengthen our commercial organization. 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.
Certainly, Jim can chime in as well. Feel free to ask us anything in the Q&A. We're happy to be as transparent as we possibly can with y'all.
Thanks, Tony. Hey, for all of you I haven't met yet. Nice to meet you. Good morning. My name's Jeff Blizzard. Just joined in June, coming off the board for a year, as Tony said. Ultimately, the reason why I joined is this is a device, a 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. 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 a big reason why I'm here.
Secondarily, in just a point of reference, after the patients, which drive your revenue, your annuity stream, as this slide focuses on second and third quarter, these are two record-breaking quarters for Tela.
Next slide. I think we can flip to the next slide while Jeff's talking. Thanks. Sorry about that, Jeff.
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. We got in here in June. We have since assessed what we need to do. One is we had a raw goods field of workers and salespeople and clinical assistants 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 startup pain that you move so quickly that you have to forgo process, which we've now instilled and bring a little bit of what our Aviomed playbook looked 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 med device cities like Chicago, like in Los Angeles. Those are key markets for us. Boston is another one. New York City, which was addressed before we got here, and New York City is one of our key markets now.
We are focusing in the last quarter now in Q4 and into 2026 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 LA. 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 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. What we're doing, and I'll have Jim chime in on this, is we're refining our data management.
Our internal use of data 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 out territory plans and ultimately even patient outcome summaries where we can go back into programs and show you've done eight great procedures, although the last one was a difficult case. Let's look at the procedures and how well they did and what worked differently. We are instilling that, and hopefully we'll roll out in January by our national sales meeting. Lastly, having data inside means 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.
I'd like to introduce Jim Hagan, who comes over, and I talked him into joining with me the same day that we left at J&J, and we just saw opportunity here. I'll let Jim tell a little bit about what we're doing next.
Thanks, Jeff. 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?" He goes, "It's an excellent product." That's really all I needed to make the jump over. 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 2026 to really focus on the tissue and the mechanism of action. While we are concurrently building up our field teams, we have the best possible clinical support bedside. We are 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 differently than any other hernia and plastic reconstructive products on the market today. That is the core of our strategy in 2026. As Tony mentioned, we have a critical product launch in the hernia portfolio happening in the early part of calendar year 2026 with Aroa's help, which should only accelerate our performance into the hernia market where we have a right to win. Some of the other investment we are making beyond just the US next year is Europe.
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 2026. I, as Jeff said, I could not be more excited to be here right now. I think the underlying product that we share with Aroa is truly differentiated. We're seeing the cracks form in the U.S. market right now. I think our upside going into 2026 as we rebuild the foundation for TELA Bio into 2027 and beyond is only going to get better.
That is really the end of any presentation, 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 how we're going to scale and grow this thing.
Okay. Let's open up firstly for questions from the room here, and then we'll go to online attendees. Any questions for the Tela team in the room? Melissa?
Thank you. Just to elaborate, you mentioned you're seeing cracks form in the US 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? Help us understand what you meant by that comment, please. Yes. I think if you look at the latest data coming out, really we're up against Phasix mostly in the plastics world right now.
I think as more experience happens on Phasix and more publications come out, 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 it 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. You are 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. I think we are really skewing into that younger generation of surgeon who's 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 the contract already locked up, as Tony talked about. Now you're starting to see clinical belief coming through. It's between the publications, the anecdotal that we're hearing from some of the customers who are switching out from BD product. 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 can get good outcomes as a relevant clinical partner in the OR, you start to see the takeoff happen relatively quickly after that. I'll just add a little bit to that. Sorry. We do VIP tours for surgeons.
I think the last two quarters, we've averaged 10 or 12 VIPs per quarter. This year particularly has been a marked 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. 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. I'd consider them to be dabblers, familiar with the product. They're aching to get into a full conversion situation. Generally, when they leave the VIP tour, we have a very high conversion rate to a full conversion. As these surgeons grow in their practice, stature, procedure volumes, we're starting to get more and more full conversions.
That really has not been the case that I can. There was the startings of it last year and maybe the year before, but this year it's starting to pick up momentum. You can just feel it when we bring these docs in. They also provide us tremendous feedback on the products, their experience with the product, and we use that knowledge to inform new product development as well.
Just to close the conversation on that, you've heard academic efforts, academic footprint. That to us embodies not only the teaching and training programs. There are over about 110 general surgery programs in the US 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.
That turns into single-center studies, turns into publications, multi-center publications. Those opinion leaders are at our conferences next year with content on their pre-approved content on Podium. We partner with them on cadaver labs. They're teaching and training programs for not only with patients, but also the residents and what they do in cadaveric labs. It allows us some fun to get in early with these users and build a clinical pathway with them. When they become first-year attendings, as Tony cited, a lot of them we're seeing now, they've got this as their pick card. They prefer this product leaving their training programs.
Hey, I'd just like to jump in with one quick question. Just a couple of comments on the impact of robotic surgery in hernia repair and what's happening there.
I'll start.
If you look at the different types of hernia, it may be as high as 70-plus % of inguinals and maybe even higher in hiatals are being done robotically. The robot is creeping up the complexity curve in hernia. Simple ventrals leading slowly but surely to moderate and more complex ventrals. I'm not sure if the worst of the worst ab wall 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. All hernias are going to be done robotically. Everything we're doing is angled around compatibility with robots. Our clinical data collection has really picked up in the last couple of years. We started off in hiatal 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. 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. When surgeons go to get their time and learning on the robot, hopefully they're starting to see some OviTex go in as well. We've made great strides in just getting adjacent into the robot.
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. A lot of the products in our pipeline, particularly the self-gripping technology, are solely designed for robot compatibility. Medtronic has a polypropylene product called ProGrip, which I think was around $30 million in sales maybe four or five years ago. It is now well over a $100 million product, all driven by the robot. I think we can catch that wave. 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. That will start to get us into those ventral procedures as the robot creeps into ventral. 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 being 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. Thank you. I think what we come away from this thinking is Tela's 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 Tela Bio.
Yeah, same here. I think the partnership with Aroa has been great, and it's going to get better and better. With that, I guess we'll sign off, Brian. Is that okay?
Yeah. Thank you. Thanks for having me.
Thank you, everyone. Thank you. Good luck, everyone. Thank you.
Okay.
What we are going to do now is transition to some talks from two surgeons. We are going to start off with Dr. Alison Smith. She is a trauma and emergency trained general surgeon, did a clinical fellowship at the University of Texas, has a PhD in biomedical sciences from Tulane, and is board-certified in general surgery and surgical critical care. She joins us today from Louisiana State University. Alison, thank you for joining, and look forward to your presentation.
Good morning. Can everyone hear me okay?
Yes.
Great. I think my slides are being loaded, but 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. A lot of real-world work going on here. This is a great opportunity as physicians.
We do not often get to see this side of it. 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 are doing is really paying off from the clinical side. I was told to give you a disclaimer that some of the images are medical images, so they might be a little bit graphic. You have been warned. The next slide. For me, Brian did a great job introducing me, kind of sums it up. I think from my standpoint, I have been using the product Myriad for about four years. I did all my training in New Orleans. I specifically focused on research during my training where I obtained not only a medical degree, but a PhD.
My PhD work was with wound healing and stem cells. I have 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 are taking care of. I have 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 have also been allowed to participate in a lot of these multi-center studies that are really impacting patients above and beyond my reach in New Orleans. That is something that is really important to me as a trauma and emergency surgeon that I am also contributing to the greater scientific community.
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. I was just asked today to kind of speak a little bit about my experience with Myriad. As I mentioned, I've used the product for about four years. I have used other products in the past. 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's some great pictures. Is this something that you want to try?" We're frequently approached as physicians.
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. 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. We think it's going to benefit your patients. We do want you to try it." 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.
At the end of the day, the bottom line for medical products and devices is always going to be cost. 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. 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. We're the only level one major trauma center in the New Orleans area and really the one in the area that also takes care of burns as well.
We get a lot of referrals for complex wounds, for trauma burn patients. We do get quite a wide catchment area of these really difficult-to-treat wounds. 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. Taking care of these complex wounds in my surgical training, you do not really learn a lot about how to manage wounds, even though it is 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. The product really fit well with what we needed. I like that we also had the sheet and the morsels. Really different uses for depending on what type of wounds my patients have because not all wounds come the same. Each one has its own unique challenges. This product really gave me versatility of how I could use it.
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. 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. 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. 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 dispositions.
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. She's had very difficult-to-treat wounds. Myriad has really helped us progress her longer. Now she's going home on Thursday with her wound vac in place. We've applied Myriad to her several times, and we finally were able to get her complex wounds to close. I think that this something really is helping us, as you can see in the slide, to help restore the tissue. You really start to see response even within seven days. You'll start to see that. This patient, over a period of weeks, we've gradually healed her wounds.
Even though she presents many challenges in terms of her body habitus, her underlying illnesses, but also the fact that she's bedbound, poor nutrition. These are all things going against us healing these wounds. Now we've gotten her to the point that she's going to go home this week with her family, which is great. She's somebody that really doesn't have other options. This product was able to provide her with a solution that healed her wounds and now is going to get her back with her family. There's very minimal complications, and that's something that I do appreciate. When I consent patients for this procedure, I tell them, "I'm going to be using this product." I tell them about Myriad. I do have some patients that actually Google it, and they're really curious to learn about it.
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." The patients always seem to like to know that there's not a harm that's going to be posed to them. 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.
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. 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. This is a study that we took part of. As I mentioned, I've been using Myriad for about four years of my practice. When we first started using the product, we were approached to be part of the clinical registry.
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 on my patient, I'm recommending for other physicians to use it, that there's research to support it. As you all know, 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. 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. 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 and my patient population, a mixture of trauma patients plus acute care surgery patients, meaning patients that have things like diabetic foot ulcers, sacral pressure ulcers, necrotizing soft tissue infections. Those are the patients that we typically will use the product on outside of the trauma population. The patients, we try to follow them for a period of several months. At minimum, we at least try to look at the wounds seven days after application. Some of these patients, we've been able to follow for months out, and we see how their wounds are healing. 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.
Knowing that the product works not only in my patient population, but it'll work in a patient population in Northeast Georgia or in Pennsylvania or in Ohio. These are diverse patient populations that we know that this product's going to work in other places. 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. This will be the first publication looking at that registry data in this multi-center approach. 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. Really, our numbers show that this works in many different types of wounds, in many different types of patients, and different types of settings.
The manuscript also commented on the financial advantage of this product because, again, when I approached my hospital and said, "Hey, I want to bring in a new product," the first question is, "How much is it going to cost us?" When I was able to show the VAT committee at my hospital who makes these decisions if I can bring in new products, that not only is this affordable, we're 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. Once I explained all of that to them, that really carried a lot of weight and allowed us to participate in that.
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. This shows kind of a breakdown of the patients. 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, avascular, meaning they weren't blood vessels. The average defect size is about 100 sq cm, which is a pretty large defect. 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.
Those wounds can be very challenging to treat because there's already a pre-existing infection. Some of the data here, you can see we used it in a lot of trauma patients, NSTIs, and 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 dehiscence, meaning the wound has opened up after a surgical procedure, intercutaneous fistula. These were my three patients that I have, patients that have injuries to their intestines that now the intestines are exposed to the environment. By placing the product, we had really good results with finally closing up some of these fistula that wouldn't close other way. Pressure injuries, which this really tends to be a very marginalized population.
These tend to be bedbound 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 bedbound, and they develop these pressure ulcers even though they're very young patients. This also poses a very challenging patient population that this product really helped us to heal some of those wounds. We also placed it in the amputation site. Whenever I do an amputation, I like to put Myriad down, the sheet down, and then close the incision site. 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.
These are just some, again, warning graphic pictures, but not so bad. These are just showing you some progression. I think in the field of wound healing, when you look at some of these outcomes, there are different metrics you can look at. Obviously, you want the wound to close. You can look at wound size. That is one thing that you can look at, time to closure. Also, just looking at the wound can give you a general sense of how it is progressing. Is it getting infected? Do you see granulation tissue, which is the stages of the wound starting to heal? Is the wound overall looking like it is starting to get stronger and healing? Another thing that this looked at as well is patient satisfaction. How did the patients feel about these wounds?
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. I've had a lot of patients subsequently referred in to me from other physicians throughout the state that say, "Hey, I've got this patient. They've got a sacral pressure ulcer. Nobody has anything else to offer them. Can you help us?" I think that Myriad really, for me, is another tool in my bucket that I can use to help these patients, especially when they've been kind of written off by other surgeons who aren't able to offer them anything else. Next slide.
Really kind of the key takeaways that I'd like you all to remember from my presentation is that I think that Myriad, number one, it's safe, it's affordable. Those are really two huge characteristics that clinicians are looking at these days, especially when healthcare 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. 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. Don't feel bad. You feel like you're really doing something for 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.
Oftentimes, the wounds can heal after a single application. If it is a really challenging wound and it requires more than one application, then the cost is not prohibitive for you to continue to put the product on as needed. There is 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 is 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. When you try to close the leg, 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 to come back, but she was also kind of caught in the situation of not having funding and an ability to get that procedure. Our Myriad rep actually worked with us to get product donated to her, and it helped her to heal her wound. That is 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 did not have Myriad, she would never have healed her wound. This is a young girl, young mother, had to get back to her life, and we were able to provide her with the ability to get her wounds healed up so she could get back to what she was doing before her trauma.
I really do believe in the product, and I do believe in the company supporting us in 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. I think that the publication, when it comes out, is going to show this multi-center wide variety experience. I know that there are other plans to do randomized control trials, which is something that really doesn't exist in the wound healing world for medical literature. I think it's great that Aroa has really tried to take this head-on and design a study that's really going to help us have sufficient evidence 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. I am happy to answer any questions that you all may have, but thank you again for allowing me this opportunity.
All right. Thank you. Let's take some questions from the room to start with. I think we've got a question over here.
Thanks, Dr. Smith. 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?
Yeah. 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. We actually had a study that we did in pigs last year where we looked at the use of Myriad in a biofilm-infected wound in a porcine model. We found that Myriad performed really well. 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.
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. I do think that that's kind of a next area that you really could look at this. I've seen it clinically i work well for my patients that have these kind of pre-existing infections.
Hi you said you have been using the product for four years. How has that journey over the four years been? And does it take a lot of trending to use that product?
He just wants to see how they're doing and what we're up to. He would come with me to my cases. I'd say my breadth of what I do surgically is pretty broad. In the terms of difficulty for using Myriad, it's really not difficult. I think the thing for me is I work in an academic institution, so I work with a lot of residents that change out. I don't have a lot of continuity in the residents helping me. 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 a case with me. Sometimes they'll place the product if the wound doesn't require necessarily a surgical intervention. We just want to place Myriad. They'll place it by themselves on the floor.
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. 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. I heard it mentioned earlier about the cadaver lab. I will say that that's something that is really huge in general for our resident education, but also for Myriad. Last spring, we used Myriad during one of our cadaver labs. I think that that was really great because it's a very controlled environment. No matter how great simulators are and AI and everything we're trying to develop, 3D printing, nothing is as good as the cadaver.
Nothing is as good as using that model. We are lucky in that we do have access to cadaveric labs. 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. I do think that from our standpoint, using it is not difficult. It is just making sure that everybody is familiar with it, especially if you have trainees that come in and out and are not always familiar with it. I would say the other piece to it was wound care nursing. We have a great team of wound care nurses, but we are often shifts in the night that they run later than I do, and I do not always see them. We did not really clue them in that we were doing this.
The first couple of times we did it, the wound care nurses did not know what we were doing. They were actually taking the Myriad off because they did not know what it was. We have had several info sessions with them that a rep helps us to host, or if we do a journal club, we invite them to it. They have really gotten on board with it. I do think that kind of spreading that knowledge throughout the hospital has been really helpful. The rest of our team is supportive of us using the product.
All right. Charlie. Yeah, you go.
I am just wondering, we hear the product is fantastic, and you are 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 sort of pushback do you get or what limitations do you find?
Yeah, that's a good question. I think from the physician side, I also heard it mentioned earlier that I do think there's maybe some generational differences in surgeons accepting new products. We do have some older surgeons, some that were a little more easy to come on board, some that had been a little bit more hesitant to come on board, but that's just kind of their approach to everything. I do think that sometimes the younger surgeons can push it a little bit just in terms of being open to trying new things. A lot of times with my older partners, it's just they're kind of set in their ways.
They have not done it. You really have to show them that this is something that could benefit them. I think we take a lot of patients back and forth to the operating room and cover for each other. I think when they have seen my patients go back that I put Myriad on, that has made them really embrace it more so and know that they have seen the results and they see that it works and it offers a solution. I think in general, the pushback is kind of probably pretty universal for most surgeons. You are skeptical of new products to some extent because we do get a lot of reps approaching us. Every day, I get an email from, "Try this product, try this product, try that product." I do think you, as a physician, have to be able to kind of filter through that.
Again, in the absence of a randomized control pile of 2,000 patients showing something superior, none of that literature exists. You really have to be careful and really try to do your own homework and know what works best for you. 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. 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.
Great. Mark.
Yeah. Also, I'm just wondering why in this field of medicine that there's such a lack of published data with different products.
Yeah. 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. I think there was just this explosion and people were just using them left and right. I think hospitals, I certainly know mine did, really clamped down on it because they were losing money. They were having these really expensive products coming in. They were expiring. People were not using them appropriately. I think that the market was really hot without having to support it with evidence. I think now that as things have changed and people have really gotten savvy and hospital systems have really clamped down on this, now you have to provide that evidence for why you are doing something.
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. I think where this product definitely, number one, 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. I do think in this sphere, that's definitely a lot of that evidence is just lacking because those trials haven't been done. They're hard to design too because you really do need probably the multi-center approach because on any given month, I only see so many sacral pressure ulcers. It'll take you time to accumulate that patient experience. I think coordinating these multi-center studies will hopefully help fill in those gaps.
Great. We're just going to take one final question. Brett.
Thanks very much. That's really useful.
You mentioned some patients are sensitive to ovine, to sheep material. I mean, what sort of percentage of patients would fit into that category? Secondly, when would you use other products? I mean, what's Myriad not perfectly suited for?
Yeah, 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 one of the contraindications. The closest I've come to it is I had one patient who was allergic to chickens. It was kind of the only other farm animal that was maybe adjacent to a sheep. Other than that, I have not come across anybody that has had a hypersensitivity reaction or a known sheep allergy. That would be a new one for me.
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 a biologic scaffold that might help more as a bridge to skin grafting in some of these wounds. In some of the other product that I've used in the past that has been synthetic, which I'm not as much of a fan of synthetic because I do think the biologic material really contributes to the overall wound healing process as opposed to an inert substance. When you have something that you've made that's synthetic, obviously you can have more desirable properties to that product.
I think it's really exciting that down the pipe, there's going to be more material coming out that when I think about 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 it is a way to be a little bit stronger to stay in place until we can skin graft the patient.
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. I think it's partly the purification process and just the homology between that material and human proteins. We're going to wrap that up there and move on to the next section. 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 lower limb salvage procedure study that we had. Lack of infections, typically healing with single applications, and the rate of tissue repair. Sort of reinforcing the overall messages for Myriad, which we're starting to see kind of universally where this product's used. Alison, thank you very much. Yeah, look forward to staying in touch. We're going to move on now to Dr. Jason Brown. Jason's an Australian. He's kind of unusual in a way in that Aroa has not really focused on commercializing our products here in Australia. We sort of stumbled across Jason at a conference.
He was at a conference where surgeons were talking about Myriad, and Jason got intrigued and really off his own bat contacted us and said, "Hey, look, I'd like to try it by Burn Center." He is based up in Brisbane, and he is a consultant to the acute surgical and trauma services there at Jamison Trauma Institute, director of the Professor Stewart Clegg Adult Burn Center in Royal Brisbane, and has extensive experience in burns, but also in trauma. Jason, welcome, and look forward to your presentation.
Thank you. Is it the big green button? See if I can get this wrong. 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 Royal Brisbane Hospital. I've worked in the burn service there for going on 15 years now, seven of which I've been director. I can understand Dr. Smith's experience because I think a lot of those same challenges we've shared over the years. I guess the purpose of this is to give some of my experience around how Myriad has impacted and changed how we manage burns in Queensland. Just as a background, burns as an injury are very common. I would challenge anyone in this room who hasn't dropped a cup of coffee on the lap or picked up a hot pan out of the oven. Thousands of burns happen every day.
Luckily, for most of those, they never have to seek medical advice. I think it is a reflection on how good our skin is, is not only protecting us, but regenerating. We get about 5,000-6,000 burns referrals a year to the burn service. These are slightly worse burns. Even of those, most of them heal on their own. They may come to clinic. They don't need an admission. The patients we're talking about are a very small percentage of all burns. They're the ones that have significant skin loss from burns. They need to be admitted to ICU. They would die without any immediate treatment. Subsequently, they usually die because of infection. Your skin does many things. It's the largest organ of your body.
One of the things you realize it does when you've lost a significant amount, it keeps the bad outside world away from the very soft inside world that is very susceptible to infection and subsequent death. In that regard, burns, and I think there was a question from Mark, why isn't there more studies? Burns is a rare disease. 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. Major burns is a rare disease, which means getting good data around what works and what doesn't is actually really hard. It takes global alliances of research to gather that data to show trends. Globally, there are very, very, very, very different approaches to practice. It is a bit of an artesian kind of approach.
I think it's a bit like cooking. There's many ways to cook a beef stroganoff, and there's many secret recipes. At the end, you have a beef stroganoff, 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. I guess my skill set is I can cut most of your skin off and still keep you alive. The superpower 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 lent on when there are big wound problems.
A lot of those wounds are from older population, our pressure areas, our necrotizing soft tissue infection, which Dr. Smith mentioned. We had a relatively busy weekend this weekend in Queensland. We had seven admissions to ICU. A quarter of them are from necrotizing soft tissue infections, not just burns. This is a spectrum of skin deficits that we have to address. Now infection is becoming a bigger and bigger part of that. Usually, a good thing about a burn, it's not infected when they come in. Your job is to prevent the infection killing them by putting a temporary coverage on that wound 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.
You have to create a temporary coverage to stop them dying before you can skin graft them. This is where some of the tools that we use really are what is the difference between surviving and not surviving an injury. 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, corneas, bone, skin is one of the main other tissues. I guess what I try and do, and I mean, the reason I went to the conference, I try and go to at least one or two American European conferences. My trick is to stay one step ahead and to be on the edge of using what we know will work on patients, especially Europeans. Americans have very different approaches.
Always trying to look at what's the next thing. One of the problems we had was tissue banks were struggling to keep up with the demand for allograft. An allograft is essentially, well, there are three types of grafts. There's homograft, which is your own, which is really what we're trying to cover your wounds with longer term. Allograft means it comes from the same species with someone else. They're from organ donors. 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. There's a whole team that does the procurement of the tissues. There's a whole screening process around communicable diseases.
That tissue is processed, and we have fresh frozen allograft. Once it is processed, it is stored at minus 80 degrees. One of our challenges is that cold chain. There has to be a whole tissue tracking to make sure there are no diseases that are 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 from between allograft and Myriad are not that different. I can tell you processing allograft, where you have to defrost it, you have to then put it on the table, you have to mesh it like a skin graft, you have to prepare it. Each sheet we use could take 5-10 minutes. Whereas Myriad is basically open the packet, put saline on, it is ready to go.
Now, that's important because I think operating costs on average cost about $2,500-$3,000 an hour. Every minute you save, that's $50. When the difference is between one minute per sheet versus 5-10 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. Certainly, one of the biggest things is its simplicity to use. It's kept on the shelf. I don't have to keep it in the minus 80 freezer. I don't have to make sure the stock's turned over and we're using the right piece and it's not defrosting or the freezer isn't going down because the uninterruptible power supply has gone out or there's been a thunderstorm. From that regard, it's so much less stressful.
The question is, could Myriad Matrix replace the use of allograft equivalent? About a year and a half, as Brian mentioned, I was at a burns conference. As I do, I look at the products, and this was the question in my head, 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. Usually, my challenge is Australia is a small addressable market in terms of burns. Usually, I go around checking the ARTG, TGA listing, and most of them aren't listed. There's often a conversation, which is, would you bring this in? When I went to the Aroa stand, by times most prized, this was a listed product, and I never heard of it.
I asked the guys there, and they linked me in with some of the Aroa guys in New Zealand. I just had a call with them, and I said, "Hey, how do I get this? I need to try it out." They were very, very accommodating in terms of, "Yep, where you're based, we'll send you out some samples." When we talk about training to use the product, I had zero training. Having said that, I've used many, many products over the years, done many first-in-human trials, done validation trials for other products. Probably in that regard, we've got enough experience to work it through.
We started small on different use cases where we used allograft, whether it's a wound that was going to heal on sensitive areas, whether it was a difficult infected wound, a necrotizing 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 grafts like fishnet. Often, we put a sandwich graft over the top of that to help protect the skin graft so it can grow in under it. Every single use case of allograft that we used Myriad on, it was performed as well, if not better than allograft did. 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 earlier this year, and they haven't been able to supply us with allograft for nine months. If it wasn't for this serendipitous find, we would have been a whole world of pain in terms of temporary coverage for burns patients. Having said that, I think it's worked out quite well. Quick presentation, but I think it 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 Polynova's Novasorb, how that would work, if that works in that case. Yeah, we use a lot of Novasorb, 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. I've had cases where I've used BTM over Myriad. BTM needs a very healthy, clean, vascularized tissue bed. It's a dermal substitute. It will create a neodermis. Without that, it fails miserably. Everything you put on needs a vascular bed. Myriad, you can put on to a compromised wound, whether that's contaminated or on structures that aren't well vascularized, like bone 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.
You're not worried about scar and function. You're worried about wound closure before they die of something. Myriad's really effective there. We use both tools. I don't think one replaces the other. If you think one's in competition with the other, then you don't quite understand where Myriad's strengths play to and BTM's strengths play to. What about for aesthetic outcomes? How does it stack up on that score? Look, I think the main thing is not so much how good the scar looks, it's how functional it is. I think that's a tricky question because I think when you use a product that gives you some coverage over vital structures like tendons 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 glide. 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. The contraction and scar that comes down the track historically been less. This is an area of no evidence. Every product, including BTM and even Integra, over 30-40 years of Integra use, there is not a lot of evidence to say it gives a better scar outcome than skin grafting alone. Even though anecdotally, and I'll tell you my experience, it does. I've got dozens of cases of Integra and BTM over the last 20 years where the scar 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 not give a better scar, I am not sure. Experience would suggest anything that builds up a neodermis, even though Myriad is not claiming to be a dermal reconstructive template, that it is a biologic scaffold, will give you a better scar outcome. Just curious, given the circumstances of your use of Myriad, given maybe the lack of allograft available at the time, going forward, how do you see that being used? I think allograft usage we would use, and it varies on. Yeah, burns is a bit cyclical. Like I said, after last weekend, I had to have a call and said, "Look, we need another 100 units to get these seven 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. The tissue banks can focus on other tissues. I can't see where I would use it unless I couldn't get Myriad Matrix. There's probably more sheep than human donors available.
Thanks for the question. With allograft, if you sort of think about large surface area burns, are you using allograft on 100% of those burns? Is that a part of the staging of the reconstruction? What sort of percentage of those cases would you be using?
Yeah. I think any burn over 30%, 40%, you start to reach a limit of your donor site. You need to take your donor sites more than once to cover that burn. Somewhere along the line, you've got to temporize their wounds to f acilitate that.
That temporizing membrane could be Polynova, 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 bout of infection somewhere. When you get infection, your salvage option is usually allograft or another biologic because biologics are much more resistant to infection, and Myriad's proved that. I think every burn over 30-40%, we would use Myriad somewhere in that, whether it was a temporization bridge or whether it was a secondary layer over a very widely meshed skin graft. We've also are lucky enough to have our own skin culture lab. We actually grow patient skin for those patients as well. We've used Myriad in combination with cultured keratinocyte sheets, and it's worked really well as well.
Cultured sheets, they're not a replacement for skin graft. They're very finicky about how well they take for many reasons. We're trying to develop through research a better way to do that. 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 meshed skin graft of the own patient skin and get a better outcome with that. We're lucky enough to have a dedicated lab and to also add that to our toolbox of approaches for patients with significant burns, wounds, and skin loss.
Yeah, just one more for me. Are you the sole user of the product at your hospital? How would you consider the adoption rate amongst your peers?
Look, I'm in the good position that I'm the director and my peers do what I tell them to do. We have six surgeons on staff in the burn service. We work as a team. It's a team sport. We all follow the same model of care. We don't have patients under our bedcard. If you're admitted to the burn service, you're under the team. Yesterday, we had four surgeons working on two patients all at the same time, and there wasn't any fighting. We all take the same approach. Within the burn service, we all do the same thing. There isn't a problem. Now, there's a few other units that'll do their own thing.
Eventually, it might take them four or five years, but they'll eventually come around to realize that, yeah, what we were doing is probably the best thing when it comes to skin coverage.
What about in the rest of the state?
We are the only adult burn service for the state. The only other one, their children's, is separate. The children's are a little bit of a different kettle of fish. I think there have been several other centers around Australia that have reached out recently going, "Hey, I've heard Brisbane's using this. Can we have a chat?" I am always open to people giving me a call. They are not my problem. My only problem is Queensland and the adult burns that we treat.
Whatever is doing best for them, if anyone wants to get on board, I open the door and happy to share my experience with them.
What about other biologics? Have you used other biologics, or are they just too cost prohibitive?
No, we have several other biologics. We use Matroderm, which is a biologic dermal template. Like I said, we've used Integra. The other biologics, there aren't a lot of availability in Australia. There used to be a porcine-derived one, which I do not even think they make anymore, which we had used a number of years ago. Our primary biologic was allograft. I mean, that's the gold standard. If you do not have your own skin, allograft's the 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, 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 McGyver approach to these things. I have morselized the sheets. I just use the sheets. I have one product on the shelf. If I need to pack a cavity, I'll just snip it up into little pieces. If I need one layer out of the three layers, I'll separate it to one layer because I think on a dermal superficial burn, I don't need three layers. I'm not building up tissue. It's nice to have it pre-prepared, but I like to keep supply chain and stock simple. Just give me one thing, and I'll just make it work.
There's been a lot of comments just around different, you've talked about burns, but different considerations and things like NSTIs. Do you see any difference or same general principles? What is it in those sorts of things that Myriad lends itself to?
Yeah, look, I think what we're seeing and the rise of necrotizing soft tissue infections is people are living longer. We're a victim of our own success in medicine. We keep people alive longer. We're seeing patients who are significantly immunosuppressed, have diabetes, have had 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. I think burns patients, our main kind of the biggest cohort is males between the ages 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 you're dealing with a compromised patient. They're already a challenge. They're already dying of their bone marrow failure, their kidney failure, their other endocrine failure from diabetes. To get anything to work in these guys is really tough. If you try and salvage a limb in a significantly impaired, obese diabetic patient who's got a necrotizing soft tissue infection, it is not easy. 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 to the healthcare system in the last few months of our life.
The less you can reduce that, and the more you can reduce that burden, the more we can make healthcare more affordable. I've been impressed because there've been a number of patients that these were unsalvageable as far as I was concerned. We've used Myriad. I've been surprised by how well it has worked. It's got these people out the door with their limbs still attached to them. Like I said, I deal in things that work. If something works, it's cost-effective because it gets the job done and gets people out of hospital and gets them back. Myriad's one of those things.
What do you think is the biggest hurdle to Myriad being more widely adopted for burns? The biggest hurdle? Hurdle.
Stubbornness and the fact that most of the burn centers are run by plastic surgeons that are a little bit more ingrained in what they do and not open to change. Yeah. As soon as I do not 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. You need to step aside when that happens. I was interested in the OviTex talk because I used to do a lot of complex abdominal wall reconstructions. 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 is like old dog, new tricks. I think when that happens, I would not be director anymore.
Actually, I mean, one comment I'd make on that is that burns hasn't really been a focus for a while. In a way, we've been pulled into it probably over the last 12 to 18 months. What we've seen in a number of centers in the US is surgeons beginning to use Myriad in burns procedures. Particularly over the last six months, we've really seen sales start to grow. We've got a couple of leading burn centers now in the US that are doing studies and evaluations on the use of Myriad in burns. We've recently launched a mesh version of the Myriad product as well, more specifically for burns. I think it's an area where we will see increasing success.
You mentioned the fire at the Tissue Bank, which kind of gave this opportunity for Myriad.
Do you see when the Tissue Bank comes back that you'd move back to allografts? Would there be any pressure to move back to them when you think permanently?
No, look, I think the fire just happened to reinforce that having a backup. Because ideally, for disaster management, and we've been through a few disasters over the last 15 years, we would keep two to 500 grafts in a freezer as a backup because we could have 10 burns can get a burn center can get very quickly overwhelmed. I went to White Island, New Zealand, to help out. They were getting imported allograft from the US because they couldn't get enough of it. 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. We have had to try and produce our own at a level that would meet the demand. I would always, for the last five years, six years, I've been trying to get that two-500 graft buffer. It just has been impossible. That is why I had been actively looking for alternatives too, because if we don't have allograft, people will die in our model of care because you need something biologic to temporize some of these really difficult wounds. Like I said, Myriad's performed equivalent, if not better in some cases, and surprisingly so, than our allograft. As long as I've got a stock of Myriad, I can't see why I would go back to using allograft.
It's just more difficult and takes longer, and it's fiddlier.
Just one more question from me. You said that you can use Myriad in the vast majority of cases where you would previously use an allograft. What about in those really deep wounds or an amputation where you're trying to seal off the wound? Can you use an allograft in that sort of situation?
Not really because allograft's 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 processed decellularized dermal substitute - I can't remember the name of it - easy derm or something else like that, which is human-derived. Whereas allograft is fresh frozen. It's got an epidermis, which stops things sticking.
It also, you'll get eventually an immune response that will reject those cells because it's not decellularized. Whereas Myriad, being decellularized and just a collagen matrix that supports tissue kind of regeneration and that granulation tissue that helps wounds stick together, that is an area where you couldn't use allograft before. I have used it for that use case. Yeah.
Do you think the science is really well understood internationally? I mean, you're clearly across it, but it doesn't appear that other people have got the message yet.
I mean, the science isn't old. There's so many. There's fish substitutes. Brazil have a whole tilapia fish tissue bank that they use fresh frozen fish. There's porcine, bovine, ovine. The actual science behind a biologic matrix isn't new. It's really getting the product at a price point and with an effectiveness that proves value.
I'm not saying any of these other bovine-derived or porcine-derived xenograft-type matrices were not equivalent or as good as. Certainly, the market's flooded with them. It's really the success is in one, is it a good product? Does it work? Two, does it demonstrate value, especially in the public sector? I can think those two boxes definitely are ticked for Myriad.
Okay. I think we've probably come to the end of the questions. Jason, thank you very much. Super interesting talk. We're really pleased that you gave us a call and got started using this here in Australia. What we're going to do now is wrap up the online sort of investor presentation session. We're going to have a short break. After the break, we're going to come back and in the room have some roundtable discussions.
The way we're going to run this is 20 minutes at a table, 10 minutes of Q&A. We're going to cover four different topics. We're going to talk about our commercial strategy. We're going to 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 Aroa management team. Hopefully, this morning's been interesting. I think certainly a great group of presenters, hopefully some new insights and some confidence about what Aroa's up to. Let's wrap it up there. There's a cup of coffee outside. Come back in 10 minutes. I'd like to keep the pace on for the rest of the morning. Thank you.