MiMedx (MDXG) 10-Q2 Nov 212021 Q3 Quarterly reportFinancial data

Company Profile

Cover

Cover - shares	9 Months Ended
Cover - shares	Sep. 30, 2021	Oct. 20, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2021
Document Transition Report	false
Entity File Number	001-35887
Entity Registrant Name	MIMEDX GROUP, INC.
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-2792552
Entity Address, Address Line One	1775 West Oak Commons Ct NE
Entity Address, City or Town	Marietta
Entity Address, State or Province	GA
Entity Address, Postal Zip Code	30062
City Area Code	770
Local Phone Number	651-9100
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	MDXG
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		112,144,444
Entity Central Index Key	0001376339
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q3
Amendment Flag	false

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 90,607	$ 95,812
Accounts receivable, net	36,536	35,423
Inventory	11,196	10,361
Prepaid expenses	2,078	5,605
Income tax receivable	625	10,045
Other current assets	860	3,371
Total current assets	141,902	160,617
Property and equipment, net	9,856	11,437
Right of use asset	2,899	3,623
Goodwill	19,976	19,976
Intangible assets, net	5,620	6,004
Other assets	270	375
Total assets	180,523	202,032
Current liabilities:
Accounts payable	6,881	8,765
Accrued compensation	19,475	18,467
Accrued expenses	13,692	30,460
Other current liabilities	1,698	1,470
Total current liabilities	41,746	59,162
Long term debt, net	48,015	47,697
Other liabilities	4,076	3,755
Total liabilities	93,837	110,614
Commitments and contingencies (Note 13)
Convertible preferred stock Series B; $0.001 par value; 100,000 shares authorized, issued and outstanding at September 30, 2021 and December 31, 2020	92,494	91,568
Stockholders' deficit
Preferred stock Series A; $0.001 par value; 5,000,000 shares authorized, 0 issued and outstanding at September 30, 2021 and December 31, 2020	0	0
Common stock; $0.001 par value; 187,500,000 shares authorized; 112,703,926 issued and 111,926,898 outstanding at September 30, 2021 and 112,703,926 issued and 110,930,243 outstanding at December 31, 2020	113	113
Additional paid-in capital	162,003	158,610
Treasury stock at cost; 777,028 shares at September 30, 2021 and 1,773,683 shares at December 31, 2020	(4,000)	(7,449)
Accumulated deficit	(163,924)	(151,424)
Total stockholders' deficit	(5,808)	(150)
Total liabilities, convertible preferred stock, and stockholders’ deficit	$ 180,523	$ 202,032

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 30, 2021	Jun. 30, 2021	Dec. 31, 2020
LIABILITIES, CONVERTIBLE PREFERRED STOCK, AND STOCKHOLDERS’ DEFICIT
Series B convertible preferred stock par value (in dollars per share)	$ 0.001		$ 0.001
Series B convertible preferred stock, shares authorized (in shares)	100,000		100,000
Series B convertible preferred stock, shares issued (in shares)	100,000		100,000
Series B convertible preferred stock, shares outstanding (in shares)	100,000		100,000
Stockholders' equity:
Preferred stock, par value (in dollars per share)	$ 0.001		$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000		5,000,000
Preferred stock, shares issued (in shares)	0		0
Preferred stock, shares outstanding (in shares)	0		0
Common stock, par value (in dollars per share)	$ 0.001		$ 0.001
Common stock, shares authorized (in shares)	187,500,000
Common stock, shares issued (in shares)	112,703,926		112,703,926
Common stock, shares outstanding (in shares)		111,926,898	110,930,243
Treasury stock, shares (in shares)	777,028		1,773,683

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Income Statement [Abstract]
Net sales	$ 63,074	$ 64,303	$ 191,206	$ 179,686
Cost of sales	10,129	10,289	32,530	28,513
Gross profit	52,945	54,014	158,676	151,173
Operating expenses:
Selling, general and administrative	46,289	48,046	145,291	132,316
Investigation, restatement and related	3,170	12,027	8,304	39,065
Research and development	4,368	3,372	12,770	8,281
Amortization of intangible assets	193	276	647	818
Operating loss	(1,075)	(9,707)	(8,336)	(29,307)
Other expense, net
Loss on extinguishment of debt	0	(8,201)	0	(8,201)
Interest expense, net	(963)	(1,472)	(3,806)	(6,433)
Other income (expense), net	0	1	(3)	(2)
Loss before income tax provision	(2,038)	(19,379)	(12,145)	(43,943)
Income tax provision (expense) benefit	(301)	(38)	(355)	11,239
Net loss	(2,339)	(19,417)	(12,500)	(32,704)
Net loss available to common shareholders (Note 9)	$ (3,913)	$ (51,982)	$ (17,039)	$ (65,269)
Net loss per common share - basic (in dollars per share)	$ (0.04)	$ (0.48)	$ (0.15)	$ (0.60)
Net loss per common share - diluted (in dollars per share)	$ (0.04)	$ (0.48)	$ (0.15)	$ (0.60)
Weighted average common shares outstanding - basic (in shares)	110,717,073	108,493,208	110,136,517	108,222,419
Weighted average common shares outstanding - diluted (in shares)	110,717,073	108,493,208	110,136,517	108,222,419

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' DEFICIT - USD ($) $ in Thousands	Total	Revision of Prior Period, Adjustment	Common Stock Issued	Additional Paid-in Capital	Additional Paid-in CapitalRevision of Prior Period, Adjustment	Treasury Stock	Treasury StockRevision of Prior Period, Adjustment	Accumulated Deficit
Balance beginning of period (in shares) at Dec. 31, 2019			112,703,926			1,885,277
Balance, beginning of period at Dec. 31, 2019	$ 34,398		$ 113	$ 147,231		$ (10,806)		$ (102,140)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of Series B Convertible Preferred Stock	32,954			32,954
Deemed dividends	(31,568)			(31,568)
Share-based compensation expense	11,829			11,829
Exercise of stock options	370			(1,986)		$ 2,356
Exercise of stock options (in shares)						(265,300)
Issuance of restricted stock	0			(2,939)		$ 2,939
Issuance of restricted stock (in shares)						(328,894)
Restricted stock canceled/forfeited	0			2,650		$ (2,650)
Restricted stock canceled/forfeited (in shares)						345,052
Shares repurchased for tax withholding (in shares)						476,057
Shares repurchased for tax withholding	(2,409)			147		$ (2,556)
Net loss	(32,704)							(32,704)
Balance end of period (in shares) at Sep. 30, 2020			112,703,926			2,112,192
Balance, end of period at Sep. 30, 2020	12,870		$ 113	158,318		$ (10,717)		(134,844)
Balance beginning of period (in shares) at Jun. 30, 2020			112,703,926			2,412,522
Balance, beginning of period at Jun. 30, 2020	22,860		$ 113	151,625		$ (13,451)		(115,427)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of Series B Convertible Preferred Stock	32,954			32,954
Deemed dividends	(31,568)			(31,568)
Share-based compensation expense	8,048			8,048
Exercise of stock options	72			(328)		$ 400
Exercise of stock options (in shares)						(45,000)
Issuance of restricted stock	0			(2,939)		$ 2,939
Issuance of restricted stock (in shares)						(328,894)
Restricted stock canceled/forfeited	0			526		$ (526)
Restricted stock canceled/forfeited (in shares)						59,441
Shares repurchased for tax withholding (in shares)						14,123
Shares repurchased for tax withholding	(79)					$ (79)
Net loss	(19,417)							(19,417)
Balance end of period (in shares) at Sep. 30, 2020			112,703,926			2,112,192
Balance, end of period at Sep. 30, 2020	$ 12,870		$ 113	158,318		$ (10,717)		(134,844)
Balance beginning of period (in shares) at Dec. 31, 2020	112,703,926		112,703,926			1,773,683
Balance, beginning of period at Dec. 31, 2020	$ (150)		$ 113	158,610		$ (7,449)		(151,424)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Correction of out-of-period error (Note 1) \| Stock Award Misstatements							$ 2,000
Balance end of period (in shares) at Jun. 30, 2021			112,703,926			821,988
Balance, end of period at Jun. 30, 2021	$ (7,137)		$ 113	158,720		$ (4,385)		(161,585)
Balance beginning of period (in shares) at Dec. 31, 2020	112,703,926		112,703,926			1,773,683
Balance, beginning of period at Dec. 31, 2020	$ (150)		$ 113	158,610		$ (7,449)		(151,424)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Correction of out-of-period error (Note 1) \| Stock Award Misstatements		$ 0			$ (2,009)		$ 2,009
Correction of out-of-period error (Note 1) (in shares) \| Stock Award Misstatements							(239,502)
Deemed dividends	(926)			(926)
Share-based compensation expense	11,115			11,115
Exercise of stock options	$ 1,404			(1,184)		$ 2,588
Exercise of stock options (in shares)	(524,171)					(482,361)
Issuance of restricted stock	$ 0			(4,053)		$ 4,053
Issuance of restricted stock (in shares)						(810,405)
Restricted stock canceled/forfeited	0			450		$ (450)
Restricted stock canceled/forfeited (in shares)						66,374
Shares repurchased for tax withholding (in shares)						469,239
Shares repurchased for tax withholding	(4,751)					$ (4,751)
Net loss	$ (12,500)							(12,500)
Balance end of period (in shares) at Sep. 30, 2021	112,703,926		112,703,926			777,028
Balance, end of period at Sep. 30, 2021	$ (5,808)		$ 113	162,003		$ (4,000)		(163,924)
Balance beginning of period (in shares) at Jun. 30, 2021			112,703,926			821,988
Balance, beginning of period at Jun. 30, 2021	(7,137)		$ 113	158,720		$ (4,385)		(161,585)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	3,811			3,811
Exercise of stock options	45			(250)		$ 295
Exercise of stock options (in shares)						(30,032)
Issuance of restricted stock	0			(477)		$ 477
Issuance of restricted stock (in shares)						(48,630)
Restricted stock canceled/forfeited	0			199		$ (199)
Restricted stock canceled/forfeited (in shares)						18,348
Shares repurchased for tax withholding (in shares)						15,354
Shares repurchased for tax withholding	(188)					$ (188)
Net loss	$ (2,339)							(2,339)
Balance end of period (in shares) at Sep. 30, 2021	112,703,926		112,703,926			777,028
Balance, end of period at Sep. 30, 2021	$ (5,808)		$ 113	$ 162,003		$ (4,000)		$ (163,924)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Cash flows from operating activities:
Net loss	$ (12,500)	$ (32,704)
Adjustments to reconcile net loss to net cash flows provided by (used in) operating activities:
Share-based compensation	11,115	11,452
Depreciation	3,390	4,494
Amortization of intangible assets	647	818
Amortization of deferred financing costs	943	1,811
Non-cash lease expenses	724	702
Accretion of asset retirement obligation	57	0
Loss on fixed asset disposal	236	0
Loss on extinguishment of debt	0	8,201
Increase (decrease) in cash resulting from changes in:
Accounts receivable	(1,113)	(715)
Inventory	(835)	(1,919)
Prepaid expenses	3,527	5,177
Income taxes	9,420	(10,835)
Other assets	1,990	1,633
Accounts payable	(828)	339
Accrued compensation	2,085	(2,775)
Accrued expenses	(16,768)	(4,835)
Other liabilities	(840)	(840)
Net cash flows provided by (used in) operating activities	1,250	(19,996)
Cash flows from investing activities:
Purchases of equipment	(2,893)	(2,073)
Principal payments from note receivable	75	0
Patent application costs	(263)	(209)
Net cash flows used in investing activities	(3,081)	(2,282)
Cash flows from financing activities:
Proceeds from exercise of stock options	1,404	370
Stock repurchased for tax withholdings on vesting of restricted stock	(4,751)	(2,409)
Principal payments on finance lease	(27)	0
Deferred financing cost	0	(2,782)
Repayment of term loans	0	(83,872)
Proceeds from term loans	0	59,500
Proceeds from sale of Series B convertible preferred stock	0	100,000
Stock issuance costs	0	(6,564)
Prepayment premium on early repayment of term loan	0	(1,439)
Net cash flows (used in) provided by financing activities	(3,374)	62,804
Net change in cash	(5,205)	40,526
Cash and cash equivalents, beginning of period	95,812	69,069
Cash and cash equivalents, end of period	$ 90,607	$ 109,595

Nature of Business

Nature of Business	9 Months Ended
Nature of Business	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Nature of Business	Nature of Business MiMedx Group, Inc. (together with its subsidiaries, except where the context otherwise requires, “ MiMedx ,” or the “ Company ”) is an industry leader in utilizing amniotic tissue as a platform for regenerative medicine, developing and distributing placental tissue allografts with patent-protected, proprietary processes for multiple sectors of healthcare. As a pioneer in placental biologics, MiMedx has both a base business, focused on addressing the needs of patients with acute and chronic non-healing wounds, and a promising late-stage pipeline targeted at decreasing pain and improving function for patients with degenerative musculoskeletal conditions. The Company derives its products from human placental tissues and processes these tissues using its proprietary methods, including the PURION® process. MiMedx employs Current Good Tissue Practices, Current Good Manufacturing Practices, and terminal sterilization to produce its allografts. MiMedx provides products primarily in the wound care, burn, and surgical sectors of healthcare. All of its products are regulated by the United States Food and Drug Administration (“ FDA ”). The Company’s business model is focused primarily on the United States of America, but the Company is pursuing opportunities for international expansion. Enforcement Discretion In November 2017, the FDA published a series of guidances that established an updated framework for the regulation of cellular and tissue-based products. These guidances clarified the FDA’s views about the criteria that differentiate those products subject to regulation under Section 361 of the Public Health Service Act from those considered to be drugs, devices, and/or biological products subject to licensure under Section 351 of the Public Health Service Act and related regulations. The Company identified its micronized and particulate products as being subject to regulation under Section 351, requiring pre-market approval from the FDA for a specified indication with demonstrated clinical efficacy. The FDA exercised enforcement discretion with respect to Investigational New Drug (“ IND ”) applications and pre-market approval requirements through May 31, 2021. As of May 31, 2021, the Company stopped marketing its Section 351 products in the United States and is precluded from marketing such products until a Biologics License Application (“ BLA ”) is granted. If and when the FDA approves a BLA, the Company expects to be allowed to market its Section 351 products in the United States, but only for specific indications as permitted by the FDA. Sales of the Company’s Section 351 products were $0.5 million and $8.2 million for the three months ended September 30, 2021 and 2020, respectively, and $17.2 million and $23.1 million for the nine months ended September 30, 2021 and 2020, respectively. Sales of Section 351 product during the three months ended September 30, 2021 were derived from sales outside of the United States of America.. The Company currently markets EPICORD® and AMNIOCOR D® tissue products derived from human umbilical cord as providing a protective environment or as a barrier. If the FDA were to determine that EPICORD and AMNIOCORD do not meet the requirements for regulation solely under Section 361, then pre-market clearance or approval would be required. The loss of the Company’s ability to market and sell its umbilical cord-derived products would have an adverse effect on the Company’s revenue, business, financial condition, and results of operations. Net sales of the Company’s umbilical cord-derived products were $6.2 million and $4.2 million for the three months ended September 30, 2021 and 2020, respectively, and $17.1 million and $11.4 million for the nine months ended September 30, 2021 and 2020, respectively. The Company’s cord inventory, which would be at risk for write-down in the case of such a determination, was $1.5 million as of September 30, 2021. Out-of-Period Adjustment During the nine months ended September 30, 2021 , the Company identified certain Restricted Stock Unit and Performance Stock Unit awards which were not appropriately reflected in the Company’s balance of common stock outstanding beginning in 2019. The effects of these errors caused misstatements in the Company’s balance of treasury stock, additional paid-in capital, and common stock outstanding on each of the Company’s reported consolidated balance sheets and consolidated statements of stockholders’ (deficit) equity for interim and annual periods beginning with those statements as of and for the year ended December 31, 2019. The identified errors did not affect total stockholders’ (deficit) equity or earnings per share in any period. The Company recorded an out-of-period adjustment during the nine months ended September 30, 2021 , which resulted in a decrease of $2.0 million to the balance of additional paid-in capital for the nine months ended September 30, 2020, respectively, and an increase of $2.0 million to the balance of treasury stock during those same periods.

Significant Accounting Policies

Significant Accounting Policies	9 Months Ended
Significant Accounting Policies	Sep. 30, 2021
Accounting Policies [Abstract]
Significant Accounting Policies	Significant Accounting Policies Please see Note 2 to the Company’s Consolidated Financial Statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2020, filed with the Securities and Exchange Commission (“ SEC ”) on March 8, 2021 (the “ 2020 Form 10-K ”) for a description of all significant accounting policies. Basis of Presentation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“ GAAP ”) from interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation of the results of operations for the periods presented have been included. The operating results for the three and nine months ended September 30, 2021 and 2020 are not necessarily indicative of the results that may be expected for the fiscal year. The balance sheet as of December 31, 2020 was derived from the audited consolidated financial statements at that date, but does not include all of the information and footnotes required by GAAP for complete financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with the historical consolidated financial statements of the Company included in the 2020 Form 10-K. Use of Estimates The unaudited condensed consolidated financial statements have been prepared in accordance with GAAP. Conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited condensed consolidated financial statements and the reported unaudited condensed consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment and intangible assets, estimates regarding asset retirement obligations, estimates for contingent liabilities, the measurement of right-of-use assets and lease liabilities, management’s assessment of the Company’s ability to continue as a going concern, estimates of fair value of share-based payments, and valuation of deferred tax assets. In addition to the above, the Company has considered the potential effects of the Covid-19 Pandemic and potential negative impacts resulting from the end of the FDA’s period of Enforcement Discretion and other regulatory factors with respect to its determinations surrounding impairments, increases in allowances for credit losses, increases in the Company’s returns reserve, other expenses, and changes in accounting judgments that have or are reasonably likely to have a material impact on the unaudited condensed consolidated financial statements. Principles of Consolidation The unaudited condensed consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation. Change in Annual Goodwill Impairment Testing Date The Company elected to change its annual goodwill and indefinite-lived intangible asset impairment testing date from September 30 to October 1. The change in the annual impairment testing date provides the Company with more time in identifying and calculating any impairments and to maximize the use of the Company’s available resources. Because GAAP does not permit more than 12 months to pass between annual goodwill impairment tests, the Company performed quantitative tests on September 30 and October 1, 2020. As a result of each of these tests, the Company concluded that the fair value of the reporting unit exceeded the carrying value and recorded no impairment. Recently Adopted Accounting Standards In August 2020, the FASB issued Accounting Standards Update (“ ASU ”) 2020-06, “ Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity ,” which simplifies and clarifies certain calculation and presentation matters related to convertible equity and debt instruments. Specifically, this ASU simplifies the accounting for such instruments by removing requirements to separately account for conversion features as a derivative under Accounting Standards Codification (“ ASC ”) Topic 815 and removing the requirement to account for beneficial conversion features on such instruments. Accounting Standards Update 2020-06 also provides clearer guidance surrounding disclosure of such instruments and provides specific guidance for how such instruments are to be incorporated in the calculation of Diluted EPS. The guidance under ASU 2020-06 is effective for fiscal years beginning after December 15, 2021, including interim periods within those fiscal years. Early adoption is permitted, but no earlier than fiscal years beginning after December 15, 2020. The Company adopted this standard on January 1, 2021 on a modified retrospective basis. There was no impact upon adoption. Recently Issued Accounting Standards Not Yet Adopted In March 2020, the FASB issued ASU 2020-04, “ Reference Rate Reform (Topic 848) ”, which provides temporary, optional expedients and exceptions to accounting guidance for certain contract modifications and hedging arrangements to ease financial reporting burdens as a result of market transitions from the London Interbank Offered Rate (“ LIBOR ”) to alternative reference rates. The guidance is available for prospective application upon its issuance and can generally be applied to contract modifications and hedging relationships entered into beginning March 12, 2020 through December 31, 2022. As of September 30, 2021, the Company has long-term debt outstanding which carries an interest rate tied to LIBOR, the agreement for which contemplates an interest rate alternative in the event that LIBOR is unavailable. The Company is evaluating the possibility of adoption and the related impact on its financial statements. If adopted, the Company does not expect the provisions of this ASU to have a material impact on its consolidated financial statements. All other ASUs issued and not yet effective for the nine months ended September 30, 2021, and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s financial position or results of operations.

Accounts Receivable, Net

Accounts Receivable, Net	9 Months Ended
Accounts Receivable, Net	Sep. 30, 2021
Receivables [Abstract]
Accounts and Nontrade Receivable	Accounts Receivable, Net Accounts receivable consisted of the following (in thousands): September 30, 2021 December 31, 2020 Accounts receivable, gross $ 37,403 $ 36,160 Less: allowance for doubtful accounts (867) (737) Accounts receivable, net $ 36,536 $ 35,423

Inventory

Inventory	9 Months Ended
Inventory	Sep. 30, 2021
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consisted of the following (in thousands): September 30, 2021 December 31, 2020 Raw materials $ 416 $ 314 Work in process 6,064 4,316 Finished goods 4,716 5,731 Inventory $ 11,196 $ 10,361 As a result of the conclusion of the FDA’s period of Enforcement Discretion on May 31, 2021, the Company wrote down $1.0 million of its Section 351 product inventory during the nine months ended September 30, 2021. In addition, during the three and nine months ended September 30, 2021, the Company reserved $0.5 million and $0.7 million, respectively, for inventory related to product lines which have been discontinued. These amounts are included as part of cost of sales on the unaudited condensed consolidated statements of operations for those period.

Property and Equipment, Net

Property and Equipment, Net	9 Months Ended
Property and Equipment, Net	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	Property and Equipment, Net Property and equipment consisted of the following (in thousands): September 30, 2021 December 31, 2020 Leasehold improvements $ 8,745 $ 6,010 Laboratory and clean room equipment 16,497 15,524 Furniture and equipment 14,944 15,295 Construction in progress 677 3,321 Asset retirement cost 880 785 Finance lease assets 189 — Property and equipment, gross 41,932 40,935 Less accumulated depreciation (32,076) (29,498) Property and equipment, net $ 9,856 $ 11,437 Depreciation expense for each of the three and nine months ended September 30, 2021 and 2020 is summarized in the table below (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Depreciation expense $ 923 $ 1,566 $ 3,390 $ 4,494 Depreciation expense is allocated amongst cost of sales, research and development expense, and selling, general, and administrative expense on the unaudited condensed consolidated statements of operations.

Intangible Assets

Intangible Assets	9 Months Ended
Intangible Assets	Sep. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets Intangible assets are summarized as follows (in thousands): September 30, 2021 December 31, 2020 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Patents and know-how $ 9,568 $ (6,238) $ 3,330 $ 9,510 $ (5,730) $ 3,780 Licenses 1,414 (1,414) — 1,414 (1,334) 80 Customer and supplier relationships 241 (185) 56 241 (172) 69 Non-compete agreements 120 (120) — 120 (98) 22 Total amortized intangible assets $ 11,343 $ (7,957) $ 3,386 $ 11,285 $ (7,334) $ 3,951 Unamortized Intangible Assets: Tradenames and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in Process 1,226 1,226 1,045 1,045 Total intangible assets $ 13,577 $ 5,620 $ 13,338 $ 6,004 Amortization expense for the three and nine months ended September 30, 2021 and 2020 is summarized in the table below (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Amortization expense $ 193 $ 276 $ 647 $ 818 Expected future amortization of intangible assets as of September 30, 2021, is as follows (in thousands): Year ending December 31, Estimated 2021 (excluding the nine months ended September 30, 2021) $ 174 2022 695 2023 695 2024 695 2025 283 Thereafter 844 Total amortized intangible assets $ 3,386

Accrued Expenses

Accrued Expenses	9 Months Ended
Accrued Expenses	Sep. 30, 2021
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consisted of the following (in thousands): September 30, 2021 December 31, 2020 Legal costs $ 8,102 $ 24,797 Commissions to sales agents 1,809 2,141 Estimated returns 797 688 Accrued clinical trials 792 651 Accrued GPO fees 496 554 Accrued rebates 584 886 Other 1,112 743 Total $ 13,692 $ 30,460 The Company’s accrual for settlement costs, which was presented separately in previously-issued financial statements, is included as part of legal costs in the table above.

Long Term Debt

Long Term Debt	9 Months Ended
Long Term Debt	Sep. 30, 2021
Debt Disclosure [Abstract]
Long Term Debt	Long Term Debt Hayfin Term Loan Agreement On June 30, 2020, the Company entered into a Loan Agreement with, among others, Hayfin Services, LLP (“ Hayfin ”), an affiliate of Hayfin Capital Management LLP (the “ Hayfin Loan Agreement ”), which Hayfin funded (the “ Hayfin Loan Transaction ”) on July 2, 2020 (the “ Closing Date ”), providing the Company with a senior secured term loan in an aggregate amount of $50 million (the “ Term Loan ”). The Term Loan matures on June 30, 2025 (the “ Maturity Date ”). Interest is payable on the Term Loan for the balance outstanding quarterly through the Maturity Date. No principal payments on the Term Loan are due and payable until the Maturity Date. The Hayfin Loan Agreement also provided the Company an option to draw on an additional delayed draw term loan (the “ DD TL ,” collectively with the Term Loan, the “ Credit Facilities ”) in the form of a committed but undrawn facility until June 30, 2021. The Company did not exercise the option. The Credit Facilities, which are senior secured obligations, were entered into together with the sale of the Company’s Series B Convertible Preferred Stock (as defined and described in Note 10, “ Equity ”) in an aggregate amount of up to $100 million (collectively, the “ Financing Transactions ”) in order to: (1) refinance the outstanding indebtedness (the “ Refinancing ”) under the Loan Agreement, dated as of June 10, 2019 (as amended and restated, the “ BT Term Loan Agreement ”), among the Company, the lenders thereunder and Blue Torch Finance LLC as administrative agent and collateral agent for such lenders, (2) pay fees and expenses incurred with certain financing transactions, and (3) finance the working capital, capital expenditures, and other general corporate purposes of the Company. The interest rate applicable to any borrowings under the Term Loan accrues at a rate equal to LIBOR (subject to a floor of 1.5%) plus a margin of 6.75% per annum (the “ Margin ”). If LIBOR is unavailable, the Term Loan will carry interest at the Margin plus the greatest of the Prime Rate, the Federal Funds Rate plus 0.5% per annum, and 2.5%. The Margin is eligible for a reduction depending on the Company’s Total Net Leverage Ratio (as defined in the Hayfin Loan Agreement) for the quarter; as follows: • 6.5% per annum if the Total Net Leverage Ratio is less than 2.0x but greater than or equal to 1.0x, or • 6.0% per annum if the Total Net Leverage Ratio is less than 1.0x. An additional 3.0% margin is applied to the interest rate in the event of a default as defined by the Hayfin Loan Agreement. At issuance and as of September 30, 2021, the Term Loan carried an interest rate of 8.3%. The Credit Facilities contain financial covenants (as defined in the Hayfin Loan Agreement) requiring the Company, on a consolidated basis, to maintain the following: • A Maximum Total Net Leverage Ratio of 4.0x, required to be calculated on a quarterly basis. • A Minimum Liquidity of $10 million, an at-all-times financial covenant tested monthly. As of September 30, 2021, the Company is in compliance with all financial covenants required under the Hayfin Loan Agreement. The Credit Facilities also specify that any prepayment of the Term Loan, voluntary or mandatory, as defined in the Term Loan Agreement, will subject MiMedx to a prepayment premium applicable as of the date of the prepayment as follows: • On or before July 2, 2022: 2% of the principal balance repaid. • After July 2, 2022 and on or before July 2, 2023: 1% of the principal balance repaid. • After July 2, 2023: 0% of the principal balance repaid. The Loan Agreement also includes events of default customary for facilities of this type, and upon the occurrence of such events of default, subject to customary cure rights, all outstanding loans under the Credit Facilities may be accelerated or the lenders’ commitments terminated. Mandatory prepayments are also required in the event of a change in control, incurring other indebtedness, certain proceeds from disposal of assets and insured casualty event (as defined in the Hayfin Loan Agreement). Annually, beginning with the fiscal year ending December 31, 2021, the Company is required to prepay the outstanding loans based on the percentage of the Company’s Excess Cash Flow (as defined in the Hayfin Loan Agreement), if such is generated, with the percentage determined based on the Total Net Leverage thresholds. No such prepayments have been required as of September 30, 2021. Hayfin maintains a first-priority security interest in substantially all of the Company’s assets. Original issue discount and deferred financing costs incurred as part of the Financing Transactions were allocated between the sale of the Series B Convertible Preferred Stock (described below in Note 10) and the Hayfin Term Loan on the basis of the relative fair values of the transactions. The costs allocated to the Hayfin Term Loan were further allocated between the Term Loan and the DD TL on the basis of the maximum potential principal outstanding between the Credit Facilities. A summary of the allocation of the deferred financing costs and original issue discount between the Term Loan and the DD TL on July 2, 2020 was as follows (amounts in thousands): July 2, 2020 Term Loan DD TL Total Long term debt Other current assets Original issue discount $ 333 $ 167 $ 500 Deferred financing costs 2,169 1,084 3,253 Deferred financing costs and original issue discount associated with the Term Loan are amortized using the effective interest method through the Maturity Date. The amortization of such amounts are presented as part of interest expense, net on the unaudited condensed consolidated statement of operations. Unamortized deferred financing costs and original issue discount associated with the Term Loan are presented as a reduction to the principal balance on the Term Loan as part of long term debt, net on the unaudited condensed consolidated balance sheet. Deferred financing costs and original issue discount associated with the DD TL were amortized using the straight line method through the expiration of the DD TL commitment term on June 30, 2021. Amortization of these amounts are presented as part of interest expense, net on the unaudited condensed consolidated statement of operations. Unamortized deferred financing costs and original issue discount associated with the DD TL are presented as other current assets on the unaudited condensed consolidated balance sheet as of December 31, 2020. There were no such amounts outstanding as of September 30, 2021. In addition, the DD TL was subject to an additional commitment fee of 1% per annum of the amount undrawn, which is recognized as interest expense. The balances of the Term Loan as of September 30, 2021 and December 31, 2020 were as follows (amounts in thousands): September 30, 2021 December 31, 2020 Outstanding principal $ 50,000 $ 50,000 Deferred financing costs (1,721) (1,996) Original issue discount (264) (307) Long term debt $ 48,015 $ 47,697 Interest expense related to the Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Stated interest $ 1,054 $ 1,031 $ 3,116 $ 1,031 Amortization of deferred financing costs 95 90 276 90 Accretion of original issue discount 15 38 42 38 Interest expense $ 1,164 $ 1,159 $ 3,434 $ 1,159 ` Interest expense related to the DD TL, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Commitment fee $ — $ 64 126 64 Amortization of deferred financing costs — 106 542 106 Accretion of original issue discount — 125 83 125 Interest expense $ — $ 295 751 295 A summary of principal payments due on the Term Loan, by year, from September 30, 2021 through maturity are as follows (amounts in thousands): Year ending December 31, Principal 2021 (excluding the nine months ended September 30, 2021) $ — 2022 — 2023 — 2024 — 2025 50,000 Thereafter — Total long term debt $ 50,000

Net Loss Per Common Share

Net Loss Per Common Share	9 Months Ended
Net Loss Per Common Share	Sep. 30, 2021
Earnings Per Share [Abstract]
Net Loss Per Common Share	Net Loss Per Common Share Net loss per common share is calculated using two methods: basic and diluted. Basic Net Loss Per Common Share Basic net loss per common share is calculated as net loss available to common stockholders divided by weighted average common shares outstanding. Net loss available to common stockholders is calculated as net loss less (i) dividends accumulated on the Company’s Series B Convertible Preferred Stock during the period, (ii) periodic amortization of the beneficial conversion feature, and (iii) periodic accretion of the increasing-rate dividend feature. The following table provides a reconciliation of net loss to net loss available to common stockholders and calculation of basic net loss per common share for each of the three and nine months ended September 30, 2021 and 2020 (amounts in thousands, except share and per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net loss $ (2,339) $ (19,417) $ (12,500) $ (32,704) Adjustments to reconcile to net loss available to common stockholders Accumulated dividend on Series B Convertible Preferred Stock 1,574 997 3,613 997 Amortization of beneficial conversion feature — 31,110 — 31,110 Accretion of increasing-rate dividend feature — 458 926 458 Total adjustments 1,574 32,565 4,539 32,565 Net loss available to common stockholders $ (3,913) $ (51,982) $ (17,039) $ (65,269) Weighted average common shares outstanding 110,717,073 108,493,208 110,136,517 108,222,419 Basic net loss per common share $ (0.04) $ (0.48) $ (0.15) $ (0.60) Diluted Net Loss Per Common Share Diluted net loss per common share is calculated as net loss available to common stockholders, adjusted for dividends on convertible preferred stock (to the extent such conversions would be dilutive), divided by weighted average common shares outstanding plus potential common shares. The calculation of potential common shares considers incremental shares resulting from certain transactions, including the exercise of stock options and the issuance of restricted stock using the treasury stock method, as well as the hypothetical conversion of the Company’s Series B Convertible Preferred Stock using the if-converted method. The treasury stock method assumes that proceeds from the transaction are used to purchase common stock at the average market price throughout the period. The if-converted method adds back periodic accrued or deemed dividends on the Company’s Series B Convertible Preferred Stock, and assumes conversion as of the later of the beginning of the period and the original transaction date. Each individual transaction is assessed for its dilutive effect on net loss per common share. To the extent that the transaction is antidilutive or does not reduce net loss per common share, the effect is excluded from the calculation. The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net loss available to common stockholders $ (3,913) $ (51,982) $ (17,039) $ (65,269) Dividends on Series B Convertible Preferred Stock 1,574 32,565 4,539 32,565 Numerator $ (3,913) $ (51,982) $ (17,039) $ (65,269) Weighted average shares outstanding 110,717,073 108,493,208 110,136,517 108,222,419 Potential common shares (a) 30,658,193 28,625,684 30,185,813 11,032,820 Weighted average shares outstanding adjusted for potential common shares 110,717,073 108,493,208 110,136,517 108,222,419 Diluted net loss per common share $ (0.04) $ (0.48) $ (0.15) $ (0.60) (a) Potential common shares reflects hypothetical transactions involving convertible securities and share-based payment awards using the if-converted and treasury stock methods, respectively. The effect of each of these adjustments on the calculation is presented in the table below: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Series B Convertible Preferred Stock 27,027,252 25,691,700 26,497,570 8,626,410 Restricted stock awards 974,687 1,203,853 1,287,635 1,281,635 Restricted stock unit awards 1,840,483 919,233 1,500,674 359,103 Outstanding stock options 805,437 772,967 875,714 739,937 Performance stock unit awards 10,334 37,931 24,220 25,735 Potential common shares 30,658,193 28,625,684 30,185,813 11,032,820

Equity

Equity	9 Months Ended
Equity	Sep. 30, 2021
Equity [Abstract]
Equity	Equity Series B Convertible Preferred Stock The Series B Convertible Preferred Stock of the Company (the “ Series B Preferred Stock ”) paid a 4.0% cumulative dividend per annum prior to the quarterly dividend payment ending on June 30, 2021, and pays a 6.0% cumulative dividend per annum thereafter. Dividends, if declared, are paid in cash at the end of each quarter based on dividend amounts that accumulate beginning on the last payment date through the day prior to the end of each quarter. In lieu of paying a dividend, the Company may elect to accrue the dividend owed to shareholders. Accrued dividend balances accumulate dividends at the prevailing dividend rate for each dividend period for which they are outstanding. Each share of Series B Preferred Stock, including any accumulated and unpaid dividends, is convertible into the Company’s common stock at any time at the option of the Holder at a conversion price of $3.85 per common share, or 259.74 common shares for each share of Series B Preferred Stock prior to any accumulated and unpaid dividends. The Series B Preferred Stock, including any accumulated and unpaid dividends, automatically converts into common stock at any time after the third anniversary of the issuance date (July 2, 2023 for the 100,000 shares currently outstanding), provided that the common stock has traded at 200% or more of the conversion price for 20 out of the preceding 30 consecutive trading days and on the trading date immediately prior to the date of conversion, the common stock traded at 200% or more of the conversion price. Holders of the Series B Preferred Stock, voting as a class, generally are entitled to elect two members to the board of directors. Holders of the Series B Preferred Stock are entitled to vote on all matters to be voted on by the Company’s shareholders on an as-converted basis as a single class with the common stock not to exceed 19.9% of the total voting stock of the Company. Holders of the Series B Preferred Stock are also entitled to a liquidation preference in an amount equal to the original issue price plus all accumulated and unpaid dividends in the event of a liquidation, dissolution, or winding-up of the Company. The Series B Preferred Stock instrument contains an increasing-rate cumulative dividend feature. The Company determined the present value of the difference between the (1) dividends that will be payable, in the period preceding commencement of the perpetual dividend; and (2) the perpetual dividend amount for a corresponding number of periods to ascribe a fair value to this feature. The present value is calculated using a market rate for dividend yield. The Company calculated the amount of the increasing-rate dividend feature as $1.8 million. This amount is amortized as a deemed dividend to preferred shareholders using the effective interest method through the commencement date of the Perpetual Dividend Rate. During the three and nine months ended September 30, 2021, the Company recognized $0 and $0.9 million of deemed dividends related to the amortization of the increasing rate dividend feature. If the Company undergoes a change of control, the Company will have the option to repurchase some or all of the then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the liquidation preference, subject to the rights of the holders of the Series B Preferred Stock in connection with such change in control. If the Company does not exercise such repurchase right, holders of the Series B Preferred Stock will have the option to (1) require the Company to repurchase any or all of their then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the liquidation preference or (2) convert the Series B Preferred Stock, including accumulated and unpaid dividends, into common stock and receive their pro rata consideration thereunder. Because the contingent redemption of the Series B Preferred Stock by the holders in the event of change in control is outside the Company’s control, the Series B Preferred Stock is classified as temporary equity. The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended September 30, 2021 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at June 30, 2021 100,000 $ 92,494 Deemed dividends — — Balance at September 30, 2021 100,000 $ 92,494 The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended September 30, 2020 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at June 30, 2020 — $ — Issuance of Series B Preferred Stock 100,000 59,540 Deemed dividends — 31,568 Balance at September 30, 2020 100,000 $ 91,108 The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the nine months ended September 30, 2021 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at December 31, 2020 100,000 $ 91,568 Deemed dividends — 926 Balance at September 30, 2021 100,000 $ 92,494 The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the nine months ended September 30, 2020 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at December 31, 2019 — $ — Issuance of Series B Preferred Stock 100,000 59,540 Deemed dividends — 31,568 Balance at September 30, 2020 100,000 $ 91,108 The Company has not declared or paid any dividends on the Series B Convertible Preferred Stock since issuance. Dividends accumulated but not paid as of September 30, 2021 was $5.6 million. As this amount has not been declared, the Company has not recorded this amount on its unaudited condensed consolidated balance sheet as of September 30, 2021. Based on accumulated dividends as of September 30, 2021, the Series B Convertible Preferred Stock was convertible into an aggregate of 27,435,993 shares of the Company’s common stock. Restricted Stock Awards The Company has issued several classes of restricted stock awards to employees: restricted stock (“ RSAs ”), restricted stock unit awards (“ RSUs ”), and performance stock unit awards (“ PSUs ”). The following is summary information for restricted stock awards for the nine months ended September 30, 2021. As of September 30, 2021, there was $28.2 million of unrecognized share-based compensation expense related to restricted stock awards. This expense is expected to be recognized over a weighted-average period of 2.21 years, which approximates the remaining vesting period of these grants. The below table summarizes activity of unvested restricted stock awards by award type from January 1, 2021 through September 30, 2021. Unvested RSA awards noted below are included in issued and outstanding common stock as of September 30, 2021, while unvested RSUs and PSUs are not included in issued or outstanding common stock as of September 30, 2021. RSA RSU PSU Number of Weighted-Average Grant Date Number of Weighted-Average Grant Date Number of Weighted-Average Grant Date Unvested at January 1, 2021 2,175,859 $ 4.78 2,325,273 $ 5.90 35,212 $ 7.10 Granted — — 2,991,137 10.11 — — Vested (975,259) 4.94 (775,193) 5.89 (35,212) 7.10 Forfeited (66,374) 3.38 (252,486) 8.63 — — Unvested at September 30, 2021 1,134,226 $ 4.73 4,288,731 $ 8.67 — $ — Stock Options A summary of stock option activity for the nine months ended September 30, 2021 is presented below: Number of Weighted- Weighted- Aggregate Outstanding at January 1, 2021 2,025,683 $ 4.62 Granted — — Exercised (524,171) 3.40 Unvested options forfeited — — Vested options expired (50,000) 1.23 Outstanding at September 30, 2021 1,451,512 5.18 1.77 1,982,949 Exercisable at September 30, 2021 1,451,212 $ 5.18 1.77 $ 1,982,949

Income taxes

Income taxes	9 Months Ended
Income taxes	Sep. 30, 2021
Income Tax Disclosure [Abstract]
Income taxes	Income Taxes The effective tax rates for the Company were (14.8)% and (0.2)% for the three months ended September 30, 2021 and September 30, 2020, respectively. The effective tax rates for the Company were (2.9)% and 25.6%, for the nine months ended September 30, 2021 and September 30, 2020, respectively. These effective tax rates include the impact of discrete items of $0 and $11.4 million for the three months ended September 30, 2021 and September 30, 2020, respectively. The discrete items recorded for the nine months ended September 30, 2020 were primarily related to modifications to the tax rules for carryback of net operating losses as a result of the CARES Act which resulted in a federal tax refund of $11.3 million and an income tax benefit of the same amount. No benefit had been recognized with respect to the net operating losses due to a previously-recorded valuation allowance.

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities	9 Months Ended
	Sep. 30, 2021
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities	Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities Selected cash payments, receipts, and non-cash activities are as follows (in thousands): Nine Months Ended September 30, 2021 2020 Cash paid for interest $ 3,269 $ 6,308 Income taxes paid 157 213 Non-cash activities: Lease right of use asset and liability 189 — Note receivable for sale of property and equipment 75 — Purchases of equipment in accounts payable 6 — Fair value of non-cash consideration received for option exercise 380 — Deemed dividends on Series B Convertible Preferred Stock 926 31,568 Deferred financing costs — 471 Stock issuance costs — 942 Amendment fee on BT Term Loan — 722

Contractual Commitments and Con

Contractual Commitments and Contingencies	9 Months Ended
Contractual Commitments and Contingencies	Sep. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Contractual Commitments and Contingencies	Contractual Commitments and Contingencies Litigation and Regulatory Matters In the ordinary course of business, the Company and its subsidiaries are parties to numerous civil claims and lawsuits and subject to regulatory examinations, investigations, and requests for information. Some of these matters involve claims for substantial amounts. The Company’s experience has shown that the damages alleged by plaintiffs or claimants are often overstated, based on unsubstantiated legal theories, unsupported by facts, and/or bear no relation to the ultimate award that a court might grant. Additionally, the outcome of litigation and regulatory matters and the timing of ultimate resolution are inherently difficult to predict. These factors make it difficult for the Company to provide a meaningful estimate of the range of reasonably possible outcomes of claims in the aggregate or by individual claim. However, on a case-by-case basis, reserves are established for those legal claims in which it is probable that a loss will be incurred and the amount of such loss can be reasonably estimated. The Company's unaudited condensed consolidated financial statements as of September 30, 2021 reflect the Company's current best estimate of probable losses associated with these matters, including costs to comply with various settlement agreements, where applicable. The actual costs of resolving these claims, as well as the cost to resolve claims that are either not probable or not estimable at this time, may be substantially higher or lower than the amounts reserved. For more information regarding the Company’s legal proceedings, refer to Note 14, “ Commitments and Contingencies ” in the 2020 Form 10-K. As of September 30, 2021, the Company has accrued $4.0 million related to the legal proceedings. The Company paid, either directly or through its insurance providers, $7.7 million toward the resolution of legal matters involving the Company during the nine months ended September 30, 2021. In addition, the Company received funds from certain director and officer insurance policies for previously-incurred, covered legal expenses. These funds were recognized as a reduction to investigation, restatement, and related expense during the nine months ended September 30, 2021. The following is a description of certain litigation and regulatory matters: Securities Class Action On January 16, 2019, the United States District Court for the Northern District of Georgia entered an order consolidating two purported securities class actions ( MacPhee v. MiMedx Group, Inc., et al. filed February 23, 2018 and Kline v. MiMedx Group, Inc., et al. filed February 26, 2018). The order also appointed Carpenters Pension Fund of Illinois (“ CPFI ”) as lead plaintiff. On May 1, 2019, CPFI filed a consolidated amended complaint, naming as defendants the Company, Michael J. Senken, Parker H. “Pete” Petit, William C. Taylor, Christopher M. Cashman and Cherry Bekaert & Holland LLP. The amended complaint (the “Securities Class Action Complaint”) alleged violations of Section 10(b) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), Rule 10b-5 promulgated thereunder, and Section 20(a) of the Exchange Act. It asserted a class period of March 7, 2013 through June 29, 2018. Following the filing of motions to dismiss by the various defendants, CPFI was granted leave to file an amended complaint. CPFI filed its amended complaint against the Company, Michael J. Senken, Parker H. Petit, William C. Taylor, and Cherry Bekaert & Holland (Christopher Cashman was dropped as a defendant) on March 30, 2020; defendants filed motions to dismiss on May 29, 2020. On March 25, 2021, the Court granted defendants’ respective motions to dismiss, finding that CPFI lacked standing to bring the underlying claims and also could not establish loss causation because it sold all of its shares in MiMedx prior to any corrective disclosures, and dismissed the case. On April 22, 2021, CPFI filed a motion for reconsideration of the dismissal and for leave to amend to add a new plaintiff to attempt to cure the standing and loss causation issues. The Company has opposed CPFI’s motions and the hearing on the same was held on September 24, 2021. The Court has not yet ruled on the motions. Investigations Department of Defense Office of Inspector General Investigation On February 8, 2021, the Company received a subpoena issued by the Department of Defense Office of Inspector General seeking records regarding the sales of the Company’s micronized and other products to federal medical facilities and federal contracting offices, including those operated by the Department of Veterans Affairs or the Department of Defense. The subpoena also seeks information regarding the Company’s communications with the FDA regarding its products. The Company understands that the Office of the United States Attorney for the Western District of Washington Civil Division is overseeing the investigation, which is being conducted principally by agents employed by the Department of the Army Criminal Investigation Command. The Company is cooperating with the government’s investigation and at this time the Company is unable to predict the outcome of the investigation, including whether the investigation will result in any action or proceeding against us. Former Employee Litigation and Related Matters On January 12, 2021, the Company filed suit in the Circuit Court of the Eleventh Judicial District in and for Miami-Dade County, Florida ( MiMedx Group, Inc. v. Petit, et. al. ) against its former CEO, Parker H. “Pete” Petit, and its former COO, William C. Taylor, seeking a determination of its rights and obligations under indemnification agreements with Petit and Taylor following a federal jury’s guilty verdict against Petit for securities fraud and Taylor for conspiracy to commit securities fraud. The Company is seeking a declaratory judgment that it is not obligated to indemnify or advance expenses to Petit and Taylor in connection with certain cases to which Petit and Taylor are parties and also seeking to recoup amounts previously paid on behalf of Petit and Taylor in connection with such cases. On April 22, 2021, Petit and Taylor filed an answer and asserted counterclaims against the Company alleging breach of their indemnification agreements, breach of the covenant of good faith and fair dealing with respect to their indemnification agreements, and seeking a declaration that the Company remains obligated to indemnify and advance fees in connection with certain cases. Petit and Taylor simultaneously also filed a motion seeking to compel the Company to advance and reinstate its payments of Petit and Taylor’s legal expenses. The Company opposed Petit and Taylor’s motion and a hearing was set for June 23, 2021. At the joint request of the parties, the hearing was cancelled to allow the parties to attend a mediation to attempt a resolution of this matter; such mediation was held on August 11, 2021. Negotiations are ongoing. Defamation Claims On June 4, 2018, Sparrow Fund Management, LP (“Sparrow”) filed a complaint against the Company and Mr. Petit, including claims for defamation and civil conspiracy in the United States District Court for the Southern District of New York ( Sparrow Fund Management, L.P. v. MiMedx Group, Inc. et. al. ). The complaint seeks monetary damages and injunctive relief and alleges the defendants commenced a campaign to publicly discredit Sparrow by falsely claiming it was a short seller who engaged in illegal and criminal behavior by spreading false information in an attempt to manipulate the price of our common stock. On March 31, 2019, a judge granted defendants’ motions to dismiss in full, but allowed Sparrow the ability to file an amended complaint. The Magistrate has recommended Sparrow’s motion for leave to amend be granted in part and denied in part and the Judge adopted the Magistrate’s recommendation. Sparrow filed its amended complaint against MiMedx (Mr. Petit has been dropped from the lawsuit) on April 3, 2020 and the Company filed its answer. This case is in discovery. Other Matters Under the Florida Business Corporation Act and agreements with its current and former officers and directors, the Company is obligated to indemnify its current and former officers and directors who are made party to a proceeding, including a proceeding brought by or in the right of the corporation, with certain exceptions, and to advance expenses to defend such matters. The Company has already borne substantial costs to satisfy these indemnification and expense advance obligations and may continue to do so in the future. In addition to the matters described above, the Company is a party to a variety of other legal matters that arise in the ordinary course of the Company’s business, none of which is deemed to be individually material at this time. Due to the inherent uncertainty of litigation, there can be no assurance that the resolution of any particular claim or proceeding would not have a material adverse effect on the Company’s business, results of operations, financial position or liquidity.

Revenue

Revenue	9 Months Ended
Revenue	Sep. 30, 2021
Segment Reporting [Abstract]
Revenue	Revenue Disaggregation of Revenue by Product MiMedx has two primary classes of products: (1) Advanced Wound Care, or Section 361, products, consisting of its tissue and cord sheet allograft products, and (2) Section 351 products, consisting of the Company’s micronized and particulate products, which, prior to the end of Enforcement Discretion were used to treat a variety of patient needs, including both advanced wound care and musculoskeletal applications. Advanced Wound Care is further disaggregated between the Company’s Tissue/Other and Cord products. Below is a summary of net sales by each class of product (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Advanced Wound Care Tissue/Other $ 56,035 $ 50,842 $ 156,012 $ 137,975 Cord 6,247 4,227 17,093 11,387 Total Advanced Wound Care 62,282 55,069 173,105 149,362 Section 351 489 8,195 17,187 23,084 Other (1) 303 1,039 914 7,240 Total $ 63,074 $ 64,303 $ 191,206 $ 179,686 (1) “O ther” represents cash collections on the Remaining Contracts. Remaining Contracts are those contracts for which performance obligations have been satisfied as of September 30, 2019, but for which the criteria required for revenue recognition had not been met and would not be met until the ultimate collection of cash. For all practicable purposes, the Company is not able to allocate these revenues to different product groups. Disaggregation of Revenue by Customer MiMedx has two primary distribution channels: (1) direct to customers (healthcare professionals and/or facilities) (“ Direct Customers ”), and (2) sales through distributors (“ Distributors ”). Below is a summary of net sales by each customer type (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Direct Customers $ 61,087 $ 62,409 $ 184,706 $ 175,060 Distributors 1,987 1,894 6,500 4,626 Total $ 63,074 $ 64,303 $ 191,206 $ 179,686 The Company did not have significant foreign operations or a single external customer from which 10% or more of revenues were derived during the three or nine months ended September 30, 2021 or 2020. Collections on the Remaining Contracts The Company recognizes revenue from customers with balances outstanding as of September 30, 2019 for which all of the criteria necessary for revenue recognition were not met at the time of shipment and that such criteria would not be met until collection of such sales (the “ Remaining Contracts ”). This was in accordance with the change in the Company’s revenue recognition pattern beginning September 30, 2019 (the “ Transition ”). The Company defers the recognition of cost of sales associated with the Remaining Contracts until revenue is recognized and cash is collected. A summary of the effects of cash collections on the Remaining Contracts on the unaudited condensed consolidated statements of operations for each of the three and nine months ended September 30, 2021 and 2020 are as follows (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net sales $ 303 $ 1,039 $ 914 $ 7,240 Cost of sales 42 146 128 1,014 Gross profit $ 261 $ 893 $ 786 $ 6,226

Subsequent Events

Subsequent Events	9 Months Ended
Subsequent Events	Sep. 30, 2021
Subsequent Events [Abstract]
Subsequent Events	Subsequent EventsNone noted.

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	9 Months Ended
Significant Accounting Policies (Policies)	Sep. 30, 2021
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“ GAAP ”) from interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring accruals) considered necessary for a fair presentation of the results of operations for the periods presented have been included. The operating results for the three and nine months ended September 30, 2021 and 2020 are not necessarily indicative of the results that may be expected for the fiscal year. The balance sheet as of December 31, 2020 was derived from the audited consolidated financial statements at that date, but does not include all of the information and footnotes required by GAAP for complete financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with the historical consolidated financial statements of the Company included in the 2020 Form 10-K.
Use of Estimates	Use of Estimates The unaudited condensed consolidated financial statements have been prepared in accordance with GAAP. Conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited condensed consolidated financial statements and the reported unaudited condensed consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment and intangible assets, estimates regarding asset retirement obligations, estimates for contingent liabilities, the measurement of right-of-use assets and lease liabilities, management’s assessment of the Company’s ability to continue as a going concern, estimates of fair value of share-based payments, and valuation of deferred tax assets. In addition to the above, the Company has considered the potential effects of the Covid-19 Pandemic and potential negative impacts resulting from the end of the FDA’s period of Enforcement Discretion and other regulatory factors with respect to its determinations surrounding impairments, increases in allowances for credit losses, increases in the Company’s returns reserve, other expenses, and changes in accounting judgments that have or are reasonably likely to have a material impact on the unaudited condensed consolidated financial statements.
Principles of Consolidation	Principles of Consolidation The unaudited condensed consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation.
Goodwill	Change in Annual Goodwill Impairment Testing Date The Company elected to change its annual goodwill and indefinite-lived intangible asset impairment testing date from September 30 to October 1. The change in the annual impairment testing date provides the Company with more time in identifying and calculating any impairments and to maximize the use of the Company’s available resources.
Recently Issued and Adopted Accounting Standards	Recently Adopted Accounting Standards In August 2020, the FASB issued Accounting Standards Update (“ ASU ”) 2020-06, “ Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity ,” which simplifies and clarifies certain calculation and presentation matters related to convertible equity and debt instruments. Specifically, this ASU simplifies the accounting for such instruments by removing requirements to separately account for conversion features as a derivative under Accounting Standards Codification (“ ASC ”) Topic 815 and removing the requirement to account for beneficial conversion features on such instruments. Accounting Standards Update 2020-06 also provides clearer guidance surrounding disclosure of such instruments and provides specific guidance for how such instruments are to be incorporated in the calculation of Diluted EPS. The guidance under ASU 2020-06 is effective for fiscal years beginning after December 15, 2021, including interim periods within those fiscal years. Early adoption is permitted, but no earlier than fiscal years beginning after December 15, 2020. The Company adopted this standard on January 1, 2021 on a modified retrospective basis. There was no impact upon adoption. Recently Issued Accounting Standards Not Yet Adopted In March 2020, the FASB issued ASU 2020-04, “ Reference Rate Reform (Topic 848) ”, which provides temporary, optional expedients and exceptions to accounting guidance for certain contract modifications and hedging arrangements to ease financial reporting burdens as a result of market transitions from the London Interbank Offered Rate (“ LIBOR ”) to alternative reference rates. The guidance is available for prospective application upon its issuance and can generally be applied to contract modifications and hedging relationships entered into beginning March 12, 2020 through December 31, 2022. As of September 30, 2021, the Company has long-term debt outstanding which carries an interest rate tied to LIBOR, the agreement for which contemplates an interest rate alternative in the event that LIBOR is unavailable. The Company is evaluating the possibility of adoption and the related impact on its financial statements. If adopted, the Company does not expect the provisions of this ASU to have a material impact on its consolidated financial statements. All other ASUs issued and not yet effective for the nine months ended September 30, 2021, and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s financial position or results of operations.
Collections on the Remaining Contracts	Collections on the Remaining Contracts The Company recognizes revenue from customers with balances outstanding as of September 30, 2019 for which all of the criteria necessary for revenue recognition were not met at the time of shipment and that such criteria would not be met until collection of such sales (the “ Remaining Contracts ”). This was in accordance with the change in the Company’s revenue recognition pattern beginning September 30, 2019 (the “ Transition ”). The Company defers the recognition of cost of sales associated with the Remaining Contracts until revenue is recognized and cash is collected.

Accounts Receivable, Net (Table

Accounts Receivable, Net (Tables)	9 Months Ended
Accounts Receivable, Net (Tables)	Sep. 30, 2021
Receivables [Abstract]
Schedule of Accounts, Notes, Loans and Financing Receivable	Accounts receivable consisted of the following (in thousands): September 30, 2021 December 31, 2020 Accounts receivable, gross $ 37,403 $ 36,160 Less: allowance for doubtful accounts (867) (737) Accounts receivable, net $ 36,536 $ 35,423

Inventory (Tables)

Inventory (Tables)	9 Months Ended
Inventory (Tables)	Sep. 30, 2021
Inventory Disclosure [Abstract]
Inventory	Inventory consisted of the following (in thousands): September 30, 2021 December 31, 2020 Raw materials $ 416 $ 314 Work in process 6,064 4,316 Finished goods 4,716 5,731 Inventory $ 11,196 $ 10,361

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	9 Months Ended
Property and Equipment, Net (Tables)	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Summary of Property and Equipment	Property and equipment consisted of the following (in thousands): September 30, 2021 December 31, 2020 Leasehold improvements $ 8,745 $ 6,010 Laboratory and clean room equipment 16,497 15,524 Furniture and equipment 14,944 15,295 Construction in progress 677 3,321 Asset retirement cost 880 785 Finance lease assets 189 — Property and equipment, gross 41,932 40,935 Less accumulated depreciation (32,076) (29,498) Property and equipment, net $ 9,856 $ 11,437
Schedule of Depreciation Expense	Depreciation expense for each of the three and nine months ended September 30, 2021 and 2020 is summarized in the table below (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Depreciation expense $ 923 $ 1,566 $ 3,390 $ 4,494

Intangible Assets (Tables)

Intangible Assets (Tables)	9 Months Ended
Intangible Assets (Tables)	Sep. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets Activity Summary - Indefinite-lived	Intangible assets are summarized as follows (in thousands): September 30, 2021 December 31, 2020 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Patents and know-how $ 9,568 $ (6,238) $ 3,330 $ 9,510 $ (5,730) $ 3,780 Licenses 1,414 (1,414) — 1,414 (1,334) 80 Customer and supplier relationships 241 (185) 56 241 (172) 69 Non-compete agreements 120 (120) — 120 (98) 22 Total amortized intangible assets $ 11,343 $ (7,957) $ 3,386 $ 11,285 $ (7,334) $ 3,951 Unamortized Intangible Assets: Tradenames and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in Process 1,226 1,226 1,045 1,045 Total intangible assets $ 13,577 $ 5,620 $ 13,338 $ 6,004
Intangible Assets Activity Summary - Finite-lived	Intangible assets are summarized as follows (in thousands): September 30, 2021 December 31, 2020 Gross Carrying Amount Accumulated Amortization Net Carrying Amount Gross Carrying Amount Accumulated Amortization Net Carrying Amount Amortized intangible assets Patents and know-how $ 9,568 $ (6,238) $ 3,330 $ 9,510 $ (5,730) $ 3,780 Licenses 1,414 (1,414) — 1,414 (1,334) 80 Customer and supplier relationships 241 (185) 56 241 (172) 69 Non-compete agreements 120 (120) — 120 (98) 22 Total amortized intangible assets $ 11,343 $ (7,957) $ 3,386 $ 11,285 $ (7,334) $ 3,951 Unamortized Intangible Assets: Tradenames and trademarks $ 1,008 $ 1,008 $ 1,008 $ 1,008 Patents in Process 1,226 1,226 1,045 1,045 Total intangible assets $ 13,577 $ 5,620 $ 13,338 $ 6,004 Amortization expense for the three and nine months ended September 30, 2021 and 2020 is summarized in the table below (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Amortization expense $ 193 $ 276 $ 647 $ 818
Estimated Future Amortization Expense for Intangible Assets	Expected future amortization of intangible assets as of September 30, 2021, is as follows (in thousands): Year ending December 31, Estimated 2021 (excluding the nine months ended September 30, 2021) $ 174 2022 695 2023 695 2024 695 2025 283 Thereafter 844 Total amortized intangible assets $ 3,386

Accrued Expenses (Tables)

Accrued Expenses (Tables)	9 Months Ended
Accrued Expenses (Tables)	Sep. 30, 2021
Payables and Accruals [Abstract]
Schedule of Accrued Liabilities	Accrued expenses consisted of the following (in thousands): September 30, 2021 December 31, 2020 Legal costs $ 8,102 $ 24,797 Commissions to sales agents 1,809 2,141 Estimated returns 797 688 Accrued clinical trials 792 651 Accrued GPO fees 496 554 Accrued rebates 584 886 Other 1,112 743 Total $ 13,692 $ 30,460

Long Term Debt (Tables)

Long Term Debt (Tables)	9 Months Ended
Long Term Debt (Tables)	Sep. 30, 2021
Debt Disclosure [Abstract]
Schedule of Debt Issuance Costs	A summary of the allocation of the deferred financing costs and original issue discount between the Term Loan and the DD TL on July 2, 2020 was as follows (amounts in thousands): July 2, 2020 Term Loan DD TL Total Long term debt Other current assets Original issue discount $ 333 $ 167 $ 500 Deferred financing costs 2,169 1,084 3,253
Schedule of Debt	The balances of the Term Loan as of September 30, 2021 and December 31, 2020 were as follows (amounts in thousands): September 30, 2021 December 31, 2020 Outstanding principal $ 50,000 $ 50,000 Deferred financing costs (1,721) (1,996) Original issue discount (264) (307) Long term debt $ 48,015 $ 47,697
Schedule of Interest Expense	Interest expense related to the Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Stated interest $ 1,054 $ 1,031 $ 3,116 $ 1,031 Amortization of deferred financing costs 95 90 276 90 Accretion of original issue discount 15 38 42 38 Interest expense $ 1,164 $ 1,159 $ 3,434 $ 1,159 ` Interest expense related to the DD TL, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Commitment fee $ — $ 64 126 64 Amortization of deferred financing costs — 106 542 106 Accretion of original issue discount — 125 83 125 Interest expense $ — $ 295 751 295
Future Principal Payments for the Term Loan	A summary of principal payments due on the Term Loan, by year, from September 30, 2021 through maturity are as follows (amounts in thousands): Year ending December 31, Principal 2021 (excluding the nine months ended September 30, 2021) $ — 2022 — 2023 — 2024 — 2025 50,000 Thereafter — Total long term debt $ 50,000

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	9 Months Ended
Net Loss Per Common Share (Tables)	Sep. 30, 2021
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic	The following table provides a reconciliation of net loss to net loss available to common stockholders and calculation of basic net loss per common share for each of the three and nine months ended September 30, 2021 and 2020 (amounts in thousands, except share and per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net loss $ (2,339) $ (19,417) $ (12,500) $ (32,704) Adjustments to reconcile to net loss available to common stockholders Accumulated dividend on Series B Convertible Preferred Stock 1,574 997 3,613 997 Amortization of beneficial conversion feature — 31,110 — 31,110 Accretion of increasing-rate dividend feature — 458 926 458 Total adjustments 1,574 32,565 4,539 32,565 Net loss available to common stockholders $ (3,913) $ (51,982) $ (17,039) $ (65,269) Weighted average common shares outstanding 110,717,073 108,493,208 110,136,517 108,222,419 Basic net loss per common share $ (0.04) $ (0.48) $ (0.15) $ (0.60)
Schedule of Earnings Per Share, Diluted	The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per share amounts): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net loss available to common stockholders $ (3,913) $ (51,982) $ (17,039) $ (65,269) Dividends on Series B Convertible Preferred Stock 1,574 32,565 4,539 32,565 Numerator $ (3,913) $ (51,982) $ (17,039) $ (65,269) Weighted average shares outstanding 110,717,073 108,493,208 110,136,517 108,222,419 Potential common shares (a) 30,658,193 28,625,684 30,185,813 11,032,820 Weighted average shares outstanding adjusted for potential common shares 110,717,073 108,493,208 110,136,517 108,222,419 Diluted net loss per common share $ (0.04) $ (0.48) $ (0.15) $ (0.60) (a) Potential common shares reflects hypothetical transactions involving convertible securities and share-based payment awards using the if-converted and treasury stock methods, respectively. The effect of each of these adjustments on the calculation is presented in the table below: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Series B Convertible Preferred Stock 27,027,252 25,691,700 26,497,570 8,626,410 Restricted stock awards 974,687 1,203,853 1,287,635 1,281,635 Restricted stock unit awards 1,840,483 919,233 1,500,674 359,103 Outstanding stock options 805,437 772,967 875,714 739,937 Performance stock unit awards 10,334 37,931 24,220 25,735 Potential common shares 30,658,193 28,625,684 30,185,813 11,032,820
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share	The effect of each of these adjustments on the calculation is presented in the table below: Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Series B Convertible Preferred Stock 27,027,252 25,691,700 26,497,570 8,626,410 Restricted stock awards 974,687 1,203,853 1,287,635 1,281,635 Restricted stock unit awards 1,840,483 919,233 1,500,674 359,103 Outstanding stock options 805,437 772,967 875,714 739,937 Performance stock unit awards 10,334 37,931 24,220 25,735 Potential common shares 30,658,193 28,625,684 30,185,813 11,032,820

Equity Equity (Tables)

Equity Equity (Tables)	9 Months Ended
Equity Equity (Tables)	Sep. 30, 2021
Equity [Abstract]
Schedule of Series B Preferred Stock	The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended September 30, 2021 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at June 30, 2021 100,000 $ 92,494 Deemed dividends — — Balance at September 30, 2021 100,000 $ 92,494 The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended September 30, 2020 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at June 30, 2020 — $ — Issuance of Series B Preferred Stock 100,000 59,540 Deemed dividends — 31,568 Balance at September 30, 2020 100,000 $ 91,108 The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the nine months ended September 30, 2021 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at December 31, 2020 100,000 $ 91,568 Deemed dividends — 926 Balance at September 30, 2021 100,000 $ 92,494 The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the nine months ended September 30, 2020 (in thousands, except share amounts): Series B Preferred Stock Shares Amount Balance at December 31, 2019 — $ — Issuance of Series B Preferred Stock 100,000 59,540 Deemed dividends — 31,568 Balance at September 30, 2020 100,000 $ 91,108
Summary of Restricted Stock Awards by Award Type	The below table summarizes activity of unvested restricted stock awards by award type from January 1, 2021 through September 30, 2021. Unvested RSA awards noted below are included in issued and outstanding common stock as of September 30, 2021, while unvested RSUs and PSUs are not included in issued or outstanding common stock as of September 30, 2021. RSA RSU PSU Number of Weighted-Average Grant Date Number of Weighted-Average Grant Date Number of Weighted-Average Grant Date Unvested at January 1, 2021 2,175,859 $ 4.78 2,325,273 $ 5.90 35,212 $ 7.10 Granted — — 2,991,137 10.11 — — Vested (975,259) 4.94 (775,193) 5.89 (35,212) 7.10 Forfeited (66,374) 3.38 (252,486) 8.63 — — Unvested at September 30, 2021 1,134,226 $ 4.73 4,288,731 $ 8.67 — $ —
Summary of Stock Options Activity	A summary of stock option activity for the nine months ended September 30, 2021 is presented below: Number of Weighted- Weighted- Aggregate Outstanding at January 1, 2021 2,025,683 $ 4.62 Granted — — Exercised (524,171) 3.40 Unvested options forfeited — — Vested options expired (50,000) 1.23 Outstanding at September 30, 2021 1,451,512 5.18 1.77 1,982,949 Exercisable at September 30, 2021 1,451,212 $ 5.18 1.77 $ 1,982,949

Supplemental Disclosure of Ca_2

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities (Tables)	9 Months Ended
	Sep. 30, 2021
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities	Selected cash payments, receipts, and non-cash activities are as follows (in thousands): Nine Months Ended September 30, 2021 2020 Cash paid for interest $ 3,269 $ 6,308 Income taxes paid 157 213 Non-cash activities: Lease right of use asset and liability 189 — Note receivable for sale of property and equipment 75 — Purchases of equipment in accounts payable 6 — Fair value of non-cash consideration received for option exercise 380 — Deemed dividends on Series B Convertible Preferred Stock 926 31,568 Deferred financing costs — 471 Stock issuance costs — 942 Amendment fee on BT Term Loan — 722

Revenue (Tables)

Revenue (Tables)	9 Months Ended
Revenue (Tables)	Sep. 30, 2021
Segment Reporting [Abstract]
Disaggregation of Revenue	Below is a summary of net sales by each class of product (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Advanced Wound Care Tissue/Other $ 56,035 $ 50,842 $ 156,012 $ 137,975 Cord 6,247 4,227 17,093 11,387 Total Advanced Wound Care 62,282 55,069 173,105 149,362 Section 351 489 8,195 17,187 23,084 Other (1) 303 1,039 914 7,240 Total $ 63,074 $ 64,303 $ 191,206 $ 179,686 (1) “O ther” represents cash collections on the Remaining Contracts. Remaining Contracts are those contracts for which performance obligations have been satisfied as of September 30, 2019, but for which the criteria required for revenue recognition had not been met and would not be met until the ultimate collection of cash. For all practicable purposes, the Company is not able to allocate these revenues to different product groups. Below is a summary of net sales by each customer type (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Direct Customers $ 61,087 $ 62,409 $ 184,706 $ 175,060 Distributors 1,987 1,894 6,500 4,626 Total $ 63,074 $ 64,303 $ 191,206 $ 179,686
Assessment of Revenue under ASC 606	A summary of the effects of cash collections on the Remaining Contracts on the unaudited condensed consolidated statements of operations for each of the three and nine months ended September 30, 2021 and 2020 are as follows (amounts in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net sales $ 303 $ 1,039 $ 914 $ 7,240 Cost of sales 42 146 128 1,014 Gross profit $ 261 $ 893 $ 786 $ 6,226

Nature of Business (Details)

Nature of Business (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended	9 Months Ended
Nature of Business (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Sep. 30, 2020	Jun. 30, 2021	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Unusual or Infrequent Item, or Both [Line Items]
Net sales	$ 63,074	$ 64,303		$ 191,206	$ 179,686
Inventory	11,196			11,196		$ 10,361
Stock Award Misstatements \| Revision of Prior Period, Adjustment
Unusual or Infrequent Item, or Both [Line Items]
Correction of error				0
Additional Paid-in Capital \| Stock Award Misstatements \| Revision of Prior Period, Adjustment
Unusual or Infrequent Item, or Both [Line Items]
Correction of error				(2,009)
Treasury Stock \| Stock Award Misstatements \| Revision of Prior Period, Adjustment
Unusual or Infrequent Item, or Both [Line Items]
Correction of error			$ 2,000	2,009
Section 351
Unusual or Infrequent Item, or Both [Line Items]
Net sales	489	8,195		17,187	23,084
Cord
Unusual or Infrequent Item, or Both [Line Items]
Net sales	6,247	$ 4,227		17,093	$ 11,387
Inventory	$ 1,500			$ 1,500

Significant Accounting Polici_3

Significant Accounting Policies - Narrative (Details)	12 Months Ended
Significant Accounting Policies - Narrative (Details)	Dec. 31, 2020USD ($)
Accounting Policies [Abstract]
Goodwill impairment	$ 0

Accounts Receivable, Net (Detai

Accounts Receivable, Net (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Receivables [Abstract]
Accounts receivable, gross	$ 37,403	$ 36,160
Less: allowance for doubtful accounts	(867)	(737)
Accounts receivable, net	$ 36,536	$ 35,423

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
Inventory (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Sep. 30, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Raw materials	$ 416	$ 416	$ 314
Work in process	6,064	6,064	4,316
Finished goods	4,716	4,716	5,731
Inventory	11,196	11,196	$ 10,361
Inventory [Line Items]
Inventory write-down	$ 500	700
Section 351
Inventory [Line Items]
Inventory write-down		$ 1,000

Property and Equipment, Net - S

Property and Equipment, Net - Summary of Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Finance lease assets	$ 189	$ 0
Property and equipment, gross	41,932	40,935
Less accumulated depreciation	(32,076)	(29,498)
Property and equipment, net	9,856	11,437
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	8,745	6,010
Laboratory and clean room equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	16,497	15,524
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	14,944	15,295
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	677	3,321
Asset retirement cost
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 880	$ 785

Property and Equipment, Net - D

Property and Equipment, Net - Depreciation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 923	$ 1,566	$ 3,390	$ 4,494

Intangible Assets - Activity Su

Intangible Assets - Activity Summary (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 11,343	$ 11,285
Accumulated Amortization	(7,957)	(7,334)
Net Carrying Amount	3,386	3,951
Intangible assets, net	5,620	6,004
Indefinite-lived Intangible Assets [Line Items]
Intangible assets, gross carrying amount	13,577	13,338
Intangible assets, net carrying amount	5,620	6,004
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,008	1,008
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,008	1,008
Patents in Process
Finite-Lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,226	1,045
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,226	1,045
Patents and know-how
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	9,568	9,510
Accumulated Amortization	(6,238)	(5,730)
Net Carrying Amount	3,330	3,780
Licenses
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	1,414	1,414
Accumulated Amortization	(1,414)	(1,334)
Net Carrying Amount	0	80
Customer and supplier relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	241	241
Accumulated Amortization	(185)	(172)
Net Carrying Amount	56	69
Non-compete agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	120	120
Accumulated Amortization	(120)	(98)
Net Carrying Amount	$ 0	$ 22

Intangible Assets - Amortizatio

Intangible Assets - Amortization Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 193	$ 276	$ 647	$ 818

Intangible Assets - Estimated F

Intangible Assets - Estimated Future Amortization Expense for Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Estimated future amortization expense [Abstract]
2021 (excluding the nine months ended September 30, 2021)	$ 174
2022	695
2023	695
2024	695
2025	283
Thereafter	844
Net Carrying Amount	$ 3,386	$ 3,951

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Legal costs	$ 8,102	$ 24,797
Commissions to sales agents	1,809	2,141
Estimated returns	797	688
Accrued clinical trials	792	651
Accrued GPO fees	496	554
Accrued rebates	584	886
Other	1,112	743
Total	$ 13,692	$ 30,460

Long Term Debt - Term Loan (Det

Long Term Debt - Term Loan (Details) - Term loan	Jul. 02, 2020USD ($)	Sep. 30, 2022	Sep. 30, 2021USD ($)	Jul. 02, 2023	Jul. 02, 2022	Jul. 02, 2025	Jul. 02, 2025	Dec. 31, 2020USD ($)
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Principal issued	$ 50,000,000
Original issue discount			$ 264,000					$ 307,000
Hayfin Loan Agreement Term Loan \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument, interest rate, floor (percent)	1.50%
Debt instrument, basis spread on variable rate	6.75%
Default interest rate (percent)	3.00%
Interest rate at issuance (percent)			8.30%
Financing Transactions
Debt Instrument [Line Items]
Principal issued	$ 100,000,000
Credit Facilities
Debt Instrument [Line Items]
Debt covenant, minimum liquidity	10,000,000
Original issue discount	500,000
Deferred financing costs	$ 3,253,000
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Additional commitment fee (percent)	1.00%
BT Term Loan
Debt Instrument [Line Items]
Fair value of the Term Loan			$ 51,300,000
Forecast \| Hayfin Loan Agreement Term Loan, Total Net Leverage Ratio Less than 2.0x but Greater than or Equal to 1.0x \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate		6.50%
Forecast \| Hayfin Loan Agreement Term Loan, Total Net Leverage Ratio Less than 1.0x \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate		6.00%
Total net leverage ratio		1
Forecast \| Credit Facilities
Debt Instrument [Line Items]
Total net leverage ratio							4
Debt instrument, prepayment make-whole premium as percent of prepaid principal (percent)				1.00%	2.00%	0.00%
Minimum \| Hayfin Loan Agreement Term Loan \| Prime Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	0.50%
Minimum \| Forecast \| Hayfin Loan Agreement Term Loan, Total Net Leverage Ratio Less than 2.0x but Greater than or Equal to 1.0x \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Total net leverage ratio		1
Maximum \| Hayfin Loan Agreement Term Loan \| Fed Funds Effective Rate Overnight Index Swap Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	2.50%
Maximum \| Forecast \| Hayfin Loan Agreement Term Loan, Total Net Leverage Ratio Less than 2.0x but Greater than or Equal to 1.0x \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Total net leverage ratio		2

Long Term Debt - Term Loan Debt

Long Term Debt - Term Loan Debt Issuance Costs (Details) - Term loan - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020	Jul. 02, 2020
Credit Facilities
Debt Instrument [Line Items]
Original issue discount			$ 500
Deferred financing costs			3,253
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Original issue discount	$ 264	$ 307
Long term debt \| Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Original issue discount			333
Deferred financing costs			2,169
Other current assets \| Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Original issue discount			167
Deferred financing costs			$ 1,084

Long Term Debt - Term Loan Bala

Long Term Debt - Term Loan Balances (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Long term debt	$ 50,000
Term loan \| Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Outstanding principal	50,000	$ 50,000
Deferred financing costs	(1,721)	(1,996)
Original issue discount	(264)	(307)
Long term debt	$ 48,015	$ 47,697

Long Term Debt - Term Loan Inte

Long Term Debt - Term Loan Interest Expense (Details) - Term loan - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Stated interest	$ 1,054	$ 1,031	$ 3,116	$ 1,031
Amortization of deferred financing costs	95	90	276	90
Accretion of original issue discount	15	38	42	38
Interest expense	1,164	1,159	3,434	1,159
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Commitment fee	0	64	126	64
Amortization of deferred financing costs	0	106	542	106
Accretion of original issue discount	0	125	83	125
Interest expense	$ 0	$ 295	$ 751	$ 295

Long Term Debt - Term Loan Matu

Long Term Debt - Term Loan Maturity (Details) $ in Thousands	Sep. 30, 2021USD ($)
Debt Disclosure [Abstract]
2021 (excluding the nine months ended September 30, 2021)	$ 0
2022	0
2023	0
2024	0
2025	50,000
Thereafter	0
Long term debt	$ 50,000

Net Loss Per Common Share - Bas

Net Loss Per Common Share - Basic Net Loss Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Earnings Per Share [Abstract]
Net loss	$ (2,339)	$ (19,417)	$ (12,500)	$ (32,704)
Adjustments to reconcile to net loss available to common stockholders
Accumulated dividend on Series B Convertible Preferred Stock	1,574	997	3,613	997
Amortization of beneficial conversion feature	0	31,110	0	31,110
Accretion of increasing-rate dividend feature	0	458	926	458
Total adjustments	1,574	32,565	4,539	32,565
Net loss available to common stockholders	$ (3,913)	$ (51,982)	$ (17,039)	$ (65,269)
Weighted average common shares outstanding - diluted (in shares)	110,717,073	108,493,208	110,136,517	108,222,419
Weighted average common shares outstanding - basic (in shares)	110,717,073	108,493,208	110,136,517	108,222,419
Basic net loss per common share (in dollars per share)	$ (0.04)	$ (0.48)	$ (0.15)	$ (0.60)

Net Loss Per Common Share - Dil

Net Loss Per Common Share - Diluted Net Loss Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Computation of basic and diluted net loss per share [Abstract]
Net loss available to common stockholders	$ (3,913)	$ (51,982)	$ (17,039)	$ (65,269)
Dividends on Series B Convertible Preferred Stock	$ 1,574	$ 32,565	$ 4,539	$ 32,565
Weighted average shares outstanding (in shares)	110,717,073	108,493,208	110,136,517	108,222,419
Potential common shares	30,658,193	28,625,684	30,185,813	11,032,820
Weighted average shares outstanding adjusted for potential common shares	110,717,073	108,493,208	110,136,517	108,222,419
Diluted net (loss) income per common share (in dollars per share)	$ (0.04)	$ (0.48)	$ (0.15)	$ (0.60)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	30,658,193	28,625,684	30,185,813	11,032,820
Series B Convertible Preferred Stock
Computation of basic and diluted net loss per share [Abstract]
Potential common shares	27,027,252	25,691,700	26,497,570	8,626,410
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	27,027,252	25,691,700	26,497,570	8,626,410
Restricted stock awards
Computation of basic and diluted net loss per share [Abstract]
Potential common shares	974,687	1,203,853	1,287,635	1,281,635
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	974,687	1,203,853	1,287,635	1,281,635
Restricted stock unit awards
Computation of basic and diluted net loss per share [Abstract]
Potential common shares	1,840,483	919,233	1,500,674	359,103
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	1,840,483	919,233	1,500,674	359,103
Outstanding stock options
Computation of basic and diluted net loss per share [Abstract]
Potential common shares	805,437	772,967	875,714	739,937
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	805,437	772,967	875,714	739,937
Performance stock unit awards
Computation of basic and diluted net loss per share [Abstract]
Potential common shares	10,334	37,931	24,220	25,735
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	10,334	37,931	24,220	25,735

Equity - Narrative (Details)

Equity - Narrative (Details) $ / shares in Units, $ in Thousands	Jul. 02, 2020USD ($)daydirector$ / sharesshares	Sep. 30, 2021USD ($)shares	Sep. 30, 2020USD ($)shares	Sep. 30, 2021USD ($)shares	Sep. 30, 2020USD ($)shares	Jun. 30, 2021shares	Dec. 31, 2020shares	Jun. 30, 2020shares	Dec. 31, 2019shares
Dividends Payable [Line Items]
Series B convertible preferred stock, shares outstanding (in shares) \| shares		100,000		100,000			100,000
Deemed dividends			$ (31,568)	$ (926)	$ (31,568)
Series B Preferred convertible Stock, dividends accrued but not recorded for the period		$ 1,574	$ 997	3,613	$ 997
Total unrecognized compensation expense		$ 28,200		$ 28,200
Outstanding Options, weighted average remaining contractual term (in years)				2 years 2 months 15 days
Preferred Class B Convertible Stock
Dividends Payable [Line Items]
Series B preferred stock, conversion price (in dollars per share) \| $ / shares	$ 3.85
Conversion ratio of Series B preferred stock to common stock	259.74
Series B convertible preferred stock, shares outstanding (in shares) \| shares	100,000
Series B preferred stock, minimum percentage of conversion stock price to trigger conversion (percent)	200.00%
Number of trading days within consecutive day trading period common stock must exceed trigger conversion price \| day	20
Series B preferred stock, threshold number of consecutive trading days \| day	30
Series B preferred stock, minimum percentage of conversion stock price on conversion date (percent)	200.00%
Number of board seats elected by Series B preferred stockholders \| director	2
Series B preferred stock, maximum voting stock percentage on an as-converted basis (percent)	19.90%
Series B preferred stock, increasing-rate dividend feature	$ 1,800
Preferred Class B Convertible Stock \| Discounted Dividend Rate prior to Quarterly Dividend Payment ending on June 30,2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)	4.00%
Preferred Class B Convertible Stock \| Perpetual Dividend Rate after Quarterly Dividend Payment ending on June 30, 2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)	6.00%
Series B Convertible Preferred Stock
Dividends Payable [Line Items]
Series B convertible preferred stock, shares outstanding (in shares) \| shares		100,000	100,000	100,000	100,000	100,000	100,000	0	0
Deemed dividends		$ 0	$ (31,568)	$ (926)	$ (31,568)
Series B Preferred convertible Stock, dividends accrued but not recorded for the period				$ 5,600
Series B Preferred convertible stock, shares issuable upon conversion (in shares) \| shares		27,435,993		27,435,993

Equity - Changes in Series B Pr

Equity - Changes in Series B Preferred Stock (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares)			100,000
Series B Preferred Stock, outstanding, beginning			$ 91,568
Deemed dividends		$ 31,568	$ 926	$ 31,568
Series B Preferred Stock, outstanding, ending (in shares)	100,000		100,000
Series B Preferred Stock, outstanding, ending	$ 92,494		$ 92,494
Series B Convertible Preferred Stock
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares)	100,000	0	100,000	0
Series B Preferred Stock, outstanding, beginning	$ 92,494	$ 0	$ 91,568	$ 0
Issuance of Series B Preferred Stock (in shares)		100,000		100,000
Issuance of Series B Preferred Stock		$ 59,540		$ 59,540
Deemed dividends	$ 0	$ 31,568	$ 926	$ 31,568
Series B Preferred Stock, outstanding, ending (in shares)	100,000	100,000	100,000	100,000
Series B Preferred Stock, outstanding, ending	$ 92,494	$ 91,108	$ 92,494	$ 91,108

Equity - Restricted Stock Award

Equity - Restricted Stock Awards (Details)	9 Months Ended
Equity - Restricted Stock Awards (Details)	Sep. 30, 2021$ / sharesshares
Restricted stock awards
Number of Shares
Unvested, Beginning Balance (in shares) \| shares	2,175,859
Granted (in shares) \| shares	0
Vested (in shares) \| shares	(975,259)
Forfeited (in shares) \| shares	(66,374)
Unvested, Ending Balance (in shares) \| shares	1,134,226
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share) \| $ / shares	$ 4.78
Granted (in dollars per share) \| $ / shares	0
Vested (in dollars per share) \| $ / shares	4.94
Forfeited (in dollars per share) \| $ / shares	3.38
Unvested, Ending Balance (in dollars per share) \| $ / shares	$ 4.73
Restricted stock unit awards
Number of Shares
Unvested, Beginning Balance (in shares) \| shares	2,325,273
Granted (in shares) \| shares	2,991,137
Vested (in shares) \| shares	(775,193)
Forfeited (in shares) \| shares	(252,486)
Unvested, Ending Balance (in shares) \| shares	4,288,731
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share) \| $ / shares	$ 5.90
Granted (in dollars per share) \| $ / shares	10.11
Vested (in dollars per share) \| $ / shares	5.89
Forfeited (in dollars per share) \| $ / shares	8.63
Unvested, Ending Balance (in dollars per share) \| $ / shares	$ 8.67
Performance stock unit awards
Number of Shares
Unvested, Beginning Balance (in shares) \| shares	35,212
Granted (in shares) \| shares	0
Vested (in shares) \| shares	(35,212)
Forfeited (in shares) \| shares	0
Unvested, Ending Balance (in shares) \| shares	0
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share) \| $ / shares	$ 7.10
Granted (in dollars per share) \| $ / shares	0
Vested (in dollars per share) \| $ / shares	7.10
Forfeited (in dollars per share) \| $ / shares	0
Unvested, Ending Balance (in dollars per share) \| $ / shares	$ 0

Equity - Stock Incentive Plans

Equity - Stock Incentive Plans (Details) - USD ($)	9 Months Ended
Equity - Stock Incentive Plans (Details) - USD ($)	Sep. 30, 2021
Number of Shares
Outstanding, beginning of period (in shares)	2,025,683
Granted (in shares)	0
Exercised (in shares)	(524,171)
Unvested options forfeited (in shares)	(50,000)
Vested options expired (in shares)	0
Outstanding, end of period (in shares)	1,451,512
Exercisable options, vested and expected to vest (in shares)	1,451,212
Weighted- Average Exercise Price
Outstanding, beginning of period (in dollars per share)	$ 4.62
Granted (in dollars per share)	0
Exercised (in dollars per share)	3.40
Unvested options forfeited (in dollars per share)	1.23
Vested options expired (in dollars per share)	0
Outstanding, end of period (in dollars per share)	5.18
Exercisable (in dollars per share)	$ 5.18
Weighted- Average Remaining Contractual Term (in years)
Outstanding (in years)	1 year 9 months 7 days
Exercisable (in years)	1 year 9 months 7 days
Aggregate Intrinsic Value
Outstanding	$ 1,982,949
Exercisable	$ 1,982,949

Income taxes (Details)

Income taxes (Details) - USD ($)	3 Months Ended		9 Months Ended
Income taxes (Details) - USD ($)	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Income Tax Disclosure [Abstract]
Effective tax rate	(14.80%)	(0.20%)	(2.90%)	25.60%
Effective income tax rate impact of discrete items	$ 0	$ 11,400,000
Unusual or Infrequent Item, or Both [Line Items]
Income tax provision (expense) benefit	(301,000)	$ (38,000)	$ (355,000)	$ 11,239,000
Tax benefit recognized with respect to net operating loss	$ 0
CARES Act
Unusual or Infrequent Item, or Both [Line Items]
Income tax provision (expense) benefit				11,300,000
Federal tax refund				$ 11,300,000

Supplemental Disclosure of Ca_3

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Supplemental Cash Flow Elements [Abstract]
Cash paid for interest	$ 3,269	$ 6,308
Income taxes paid	157	213
Non-cash activities:
Lease right of use asset and liability	189	0
Note receivable for sale of property and equipment	75	0
Purchases of equipment in accounts payable	6	0
Fair value of non-cash consideration received for option exercise	380	0
Deemed dividends on Series B Convertible Preferred Stock	926	31,568
Deferred financing costs	0	471
Stock issuance costs	0	942
Amendment fee on BT Term Loan	$ 0	$ 722

Contractual Commitments and C_2

Contractual Commitments and Contingencies - Narrative (Details) $ in Millions	Jan. 16, 2019securityClassAction	Sep. 30, 2021USD ($)
Commitments and Contingencies Disclosure [Abstract]
Loss contingency accrual		$ 4
Payments for legal settlements		$ 7.7
Number of securities class actions \| securityClassAction	2

Revenue - Summary of Revenue by

Revenue - Summary of Revenue by Product Type (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021USD ($)product	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)product	Sep. 30, 2020USD ($)
Segment Reporting [Abstract]
Number Of Products \| product	2		2
Revenue, Major Customer [Line Items]
Net sales	$ 63,074	$ 64,303	$ 191,206	$ 179,686
Advanced Wound Care
Revenue, Major Customer [Line Items]
Net sales	62,282	55,069	173,105	149,362
Tissue/Other
Revenue, Major Customer [Line Items]
Net sales	56,035	50,842	156,012	137,975
Cord
Revenue, Major Customer [Line Items]
Net sales	6,247	4,227	17,093	11,387
Section 351
Revenue, Major Customer [Line Items]
Net sales	489	8,195	17,187	23,084
Other
Revenue, Major Customer [Line Items]
Net sales	$ 303	$ 1,039	$ 914	$ 7,240

Revenue - Summary of Revenue _2

Revenue - Summary of Revenue by Customer Type (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021USD ($)distributionChannel	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)distributionChannel	Sep. 30, 2020USD ($)
Segment Reporting [Abstract]
Number of primary distribution channels \| distributionChannel	2		2
Revenue, Major Customer [Line Items]
Net sales	$ 63,074	$ 64,303	$ 191,206	$ 179,686
Number of primary distribution channels \| distributionChannel	2		2
Direct Customers
Revenue, Major Customer [Line Items]
Net sales	$ 61,087	62,409	$ 184,706	175,060
Distributors
Revenue, Major Customer [Line Items]
Net sales	$ 1,987	$ 1,894	$ 6,500	$ 4,626

Revenue - Collections on Remain

Revenue - Collections on Remaining Contracts (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	$ 63,074	$ 64,303	$ 191,206	$ 179,686
Cost of sales	10,129	10,289	32,530	28,513
Gross Profit	52,945	54,014	158,676	151,173
Revenue Guidance Topic 606 Transition Period \| Accounting Standards Update 2014-09
Revenues from External Customers and Long-Lived Assets [Line Items]
Net sales	303	1,039	914	7,240
Cost of sales	42	146	128	1,014
Gross Profit	$ 261	$ 893	$ 786	$ 6,226