TELA Bio (TELA) 10-Q 13 Aug 20 2020 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2020	Aug. 04, 2020
Document and Entity Information
Document Type	10-Q
Document Period End Date	Jun. 30, 2020
Entity Registrant Name	TELA Bio, Inc.
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		14,414,194
Entity Central Index Key	0001561921
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q2
Amendment Flag	false

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 85,471	$ 45,302
Short-term investments	0	9,285
Accounts receivable, net	2,586	2,836
Inventory	4,572	4,603
Prepaid expenses and other assets	1,484	2,308
Total current assets	94,113	64,334
Property and equipment, net	678	677
Intangible assets, net	2,759	2,911
Total assets	97,550	67,922
Current liabilities:
Accounts payable	948	3,171
Accrued expenses and other current liabilities	2,675	3,542
Total current liabilities	3,623	6,713
Long‑term debt with related party	30,524	30,243
Other long‑term liabilities		4
Total liabilities	34,147	36,960
Stockholders’ equity:
Preferred stock; $0.001 par value: 10,000,000 shares authorized; no shares issued and outstanding
Common stock; $0.001 par value: 200,000,000 shares authorized; 14,413,015 and 11,406,976 shares issued and 14,412,690 and 11,406,221 shares outstanding at June 30, 2020 and December 31, 2019, respectively	14	11
Additional paid-in capital	244,537	198,829
Accumulated other comprehensive income (loss)	12	(19)
Accumulated deficit	(181,160)	(167,859)
Total stockholders’ equity	63,403	30,962
Total liabilities and stockholders’ equity	$ 97,550	$ 67,922

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Jun. 30, 2020	Dec. 31, 2019
Consolidated Balance Sheets
Preferred stock, Par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
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)	200,000,000	200,000,000
Common stock, shares issued (in shares)	14,413,015	11,406,976
Common stock, shares outstanding (in shares)	14,412,690	11,406,221

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Consolidated Statements of Operations and Comprehensive Loss
Revenue	$ 3,507	$ 3,303	$ 7,233	$ 6,609
Cost of revenue (excluding amortization of intangible assets)	1,346	1,320	2,796	2,752
Amortization of intangible assets	76	76	152	152
Gross profit	2,085	1,907	4,285	3,705
Operating expenses:
Sales and marketing	4,123	3,947	9,392	7,942
General and administrative	2,149	1,205	4,667	2,529
Research and development	979	1,055	1,891	2,714
Total operating expenses	7,251	6,207	15,950	13,185
Loss from operations	(5,166)	(4,300)	(11,665)	(9,480)
Other (expense) income:
Interest expense	(884)	(914)	(1,763)	(1,826)
Change in fair value of preferred stock warrant liability		(74)		(38)
Other (expense) income	(31)	27	127	117
Total other (expense) income	(915)	(961)	(1,636)	(1,747)
Net loss	(6,081)	(5,261)	(13,301)	(11,227)
Accretion of redeemable convertible preferred stock to redemption value		(2,762)		(4,787)
Net loss attributable to common stockholders	$ (6,081)	$ (8,023)	$ (13,301)	$ (16,014)
Net loss per common share, basic and diluted	$ (0.53)	$ (27.06)	$ (1.16)	$ (54.06)
Weighted average common shares outstanding, basic and diluted	11,443,122	296,467	11,424,952	296,231
Comprehensive loss:
Net loss	$ (6,081)	$ (5,261)	$ (13,301)	$ (11,227)
Foreign currency translation adjustment	4	1	31	(3)
Comprehensive Income (Loss), Net of Tax, Attributable to Parent, Total	$ (6,077)	$ (5,260)	$ (13,270)	$ (11,230)

Consolidated Statements of Rede

Consolidated Statements of Redeemable Convertible Preferred Stock and Stockholders’ Equity (Deficit) - USD ($) $ in Thousands	Series A Redeemable convertible preferred stockPreferred Stock [Member]	Series B Redeemable convertible preferred stockPreferred Stock [Member]	Common stock	Additional paid-in capital	Accumulated other comprehensive income	Accumulated deficit	Total
Balance at Beginning of period at Dec. 31, 2018	$ 33,112	$ 91,038
Balance at Beginning of period (in shares) at Dec. 31, 2018	22,501,174	63,032,500
Increase (Decrease) in Temporary Equity [Roll Forward]
Sale of Series B redeemable convertible preferred stock, net of stock issue costs		10,554,514
Sale of Series B redeemable convertible preferred stock, net of stock issue costs		$ 12,126
Accretion of redeemable convertible preferred stock to redemption value	$ 893	3,894
Balance at Ending period at Jun. 30, 2019	$ 34,005	$ 107,058
Balance at Ending period (in shares) at Jun. 30, 2019	22,501,174	73,587,014
Balance at Beginning of period at Dec. 31, 2018						$ (137,860)	$ (137,860)
Balance at Beginning of period (in shares) at Dec. 31, 2018			295,717
Increase (Decrease) in Temporary Equity [Roll Forward]
Vesting of common stock previously subject to repurchase (in shares)			295
Vesting of common stock previously subject to repurchase				$ 3			3
Exercise of stock options (in shares)			1,490
Exercise of stock options				8			8
Foreign currency translation adjustment					$ (3)		(3)
Stock-based compensation expense				119			119
Accretion of redeemable convertible preferred stock to redemption value				(130)		(4,657)	(4,787)
Net loss						(11,227)	(11,227)
Balance at Ending period at Jun. 30, 2019					(3)	(153,744)	(153,747)
Balance at Ending period (in shares) at Jun. 30, 2019			297,502
Balance at Beginning of period at Mar. 31, 2019	$ 33,556	$ 93,100
Balance at Beginning of period (in shares) at Mar. 31, 2019	22,501,174	63,463,534
Increase (Decrease) in Temporary Equity [Roll Forward]
Sale of Series B redeemable convertible preferred stock, net of stock issue costs		10,123,480
Sale of Series B redeemable convertible preferred stock, net of stock issue costs		$ 11,645
Accretion of redeemable convertible preferred stock to redemption value	$ 449	2,313
Balance at Ending period at Jun. 30, 2019	$ 34,005	$ 107,058
Balance at Ending period (in shares) at Jun. 30, 2019	22,501,174	73,587,014
Balance at Beginning of period at Mar. 31, 2019					(4)	(145,788)	(145,792)
Balance at Beginning of period (in shares) at Mar. 31, 2019			296,245
Increase (Decrease) in Temporary Equity [Roll Forward]
Vesting of common stock previously subject to repurchase (in shares)			165
Vesting of common stock previously subject to repurchase				3			3
Exercise of stock options (in shares)			1,092
Exercise of stock options				5			5
Foreign currency translation adjustment					1		1
Stock-based compensation expense				59			59
Accretion of redeemable convertible preferred stock to redemption value				(67)		(2,695)	(2,762)
Net loss						(5,261)	(5,261)
Balance at Ending period at Jun. 30, 2019					(3)	(153,744)	(153,747)
Balance at Ending period (in shares) at Jun. 30, 2019			297,502
Balance at Beginning of period at Dec. 31, 2019			$ 11	198,829	(19)	(167,859)	30,962
Balance at Beginning of period (in shares) at Dec. 31, 2019			11,406,221
Increase (Decrease) in Temporary Equity [Roll Forward]
Vesting of common stock previously subject to repurchase (in shares)			163
Vesting of common stock previously subject to repurchase				2			$ 2
Exercise of stock options (in shares)			6,306				6,306
Exercise of stock options				44			$ 44
Issuance of stock			$ 3	44,719			44,722
Issuance of stock (in shares)			3,000,000
Foreign currency translation adjustment					31		31
Stock-based compensation expense				943			943
Net loss						(13,301)	(13,301)
Balance at Ending period at Jun. 30, 2020			$ 14	244,537	12	(181,160)	63,403
Balance at Ending period (in shares) at Jun. 30, 2020			14,412,690
Balance at Beginning of period at Mar. 31, 2020			$ 11	199,287	8	(175,079)	24,227
Balance at Beginning of period (in shares) at Mar. 31, 2020			11,407,600
Increase (Decrease) in Temporary Equity [Roll Forward]
Vesting of common stock previously subject to repurchase (in shares)			73
Vesting of common stock previously subject to repurchase				1			1
Exercise of stock options (in shares)			5,017
Exercise of stock options				36			36
Issuance of stock			$ 3	44,719			44,722
Issuance of stock (in shares)			3,000,000
Foreign currency translation adjustment					4		4
Stock-based compensation expense				494			494
Net loss						(6,081)	(6,081)
Balance at Ending period at Jun. 30, 2020			$ 14	$ 244,537	$ 12	$ (181,160)	$ 63,403
Balance at Ending period (in shares) at Jun. 30, 2020			14,412,690

Consolidated Statements of Re_2

Consolidated Statements of Redeemable Convertible Preferred Stock and Stockholders’ Equity (Deficit) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019
Series B Redeemable convertible preferred stock
Stock issue costs	$ 98	$ 117

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Cash flows from operating activities:
Net loss	$ (13,301)	$ (11,227)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation expense	95	135
Noncash interest expense	281	244
Amortization of intangible assets	152	152
Inventory excess and obsolescence charge	767	916
Change in fair value of warrants		38
Stock‑based compensation expense	943	119
Change in operating assets and liabilities:
Accounts receivable	238	(599)
Inventory	(750)	(1,169)
Prepaid expenses and other assets	823	(156)
Accounts payable	(2,096)	(1,312)
Accrued expenses and other liabilities	(859)	(123)
Foreign currency remeasurement loss	45
Net cash used in operating activities	(13,662)	(12,982)
Cash flows from investing activities:
Proceeds from the sale and maturity of short-term investments	9,289
Payment for intangible asset		(500)
Purchase of property and equipment	(96)	(89)
Net cash provided by (used in) investing activities	9,193	(589)
Cash flows from financing activities:
Proceeds from underwritten public offering, net of underwriting discounts, commissions and offering costs	45,120
Payment of initial public offering costs	(522)
Proceeds from issuance of Series B redeemable convertible preferred stock, net of offering costs		12,158
Proceeds from exercise of stock options	44	8
Net cash provided by financing activities	44,642	12,166
Effect of exchange rate on cash	(4)
Net increase (decrease) in cash and cash equivalents	40,169	(1,405)
Cash and cash equivalents, beginning of period	45,302	17,278
Cash and cash equivalents, end of period	85,471	15,873
Supplemental disclosure of cash flow information:
Cash paid during the period for interest	1,482	1,582
Supplemental disclosures of noncash investing and financing activities:
Accretion of redeemable convertible preferred stock		4,787
Offering costs in accounts payable and accrued expense and other current liabilities	398	32
Intangible assets in accrued expenses and other liabilities		2,000
Issuance of common stock for early exercised stock options	$ 2	$ 3

Background

Background	6 Months Ended
	Jun. 30, 2020
Background
Background	(1) Background TELA Bio, Inc. (the “Company”) was incorporated in the state of Delaware on April 17, 2012 and wholly owns TELA Bio Limited, a company incorporated in the United Kingdom. The Company is focused on the commercialization and sale of OviTex Reinforced Tissue Matrix, which utilizes surgical reconstruction medical device technology licensed from a strategic partner and on the research and development of additional medical devices with this strategic partner and on other internally developed technologies. The Company’s principal corporate office and research facility is located in Malvern, Pennsylvania.

Risks and Liquidity

Risks and Liquidity	6 Months Ended
	Jun. 30, 2020
Risks and Liquidity
Risks and Liquidity	(2) Risks and Liquidity The Company’s operations to date have focused on commercializing products, developing and acquiring technology and assets, business planning, raising capital and organization and staffing. The Company has incurred recurring losses and negative cash flows from operations since inception and has an accumulated deficit of $181.2 million as of June 30, 2020. The Company anticipates incurring additional losses until such time, if ever, it can generate sufficient revenue from its products to cover its expenses. In November 2019, the Company closed its initial public offering (“IPO”) in which the Company issued and sold 4,398,700 shares of its common stock at a public offering price of $13.00 per share, including 398,700 shares of the Company’s common stock sold pursuant to the underwriters’ option to purchase additional shares. The Company received net proceeds of $50.6 million after deducting underwriting discounts, commissions and other offering expenses. In June 2020, the Company completed an underwritten public offering in which the Company issued and sold 3,000,000 shares of its common stock at a public offering price of $16.00 per share. The Company received net proceeds of $44.7 million after deducting underwriting discounts, commissions and other offering expenses. The operations of the Company are subject to certain risks and uncertainties including, among others, uncertainty of product development, the impact of COVID-19, the ongoing economic uncertainty, technological uncertainty, commercial acceptance of any developed products, alternative competing technologies, dependence on collaborative partners, uncertainty regarding patents and proprietary rights, comprehensive government regulations, and dependence on key personnel.

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2020
Summary of Significant Accounting Policies
Summary of Significant Accounting Policies	(3) Summary of Significant Accounting Policies The Company’s complete summary of significant accounting policies can be found in “Note 3, Summary of Significant Accounting Policies” in the December 31, 2019 consolidated financial statements included in the Company’s Annual Report. Any reference in these notes to applicable guidance is meant to refer to generally accepted accounting principles (“GAAP”) in the United States as found in the Accounting Standards Codification (“ASC”) and Accounting Standards Updates (“ASU”) promulgated by the Financial Accounting Standards Board (“FASB”). Interim Financial Statements The accompanying unaudited interim consolidated financial statements have been prepared from the books and records of the Company in accordance with GAAP for interim financial information and Rule 10‑01 of Regulation S‑X promulgated by the SEC, which permits reduced disclosures for interim periods. All adjustments, consisting only of normal recurring adjustments, necessary for a fair presentation of the accompanying consolidated balance sheets and statements of operations and comprehensive loss, redeemable convertible preferred stock and stockholders’ equity (deficit) and cash flows have been made. Although these interim consolidated financial statements do not include all of the information and footnotes required for complete annual consolidated financial statements, management believes the disclosures are adequate to make the information presented not misleading. Unaudited interim results of operations and cash flows are not necessarily indicative of the results that may be expected for the full year. Unaudited interim consolidated financial statements and footnotes should be read in conjunction with the December 31, 2019 consolidated financial statements and footnotes included in the Annual Report. Use of Estimates The preparation of consolidated financial statements in 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 contingent liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the reporting period. The most significant judgments are employed in estimates used to determine the fair value of stock‑based awards issued and recoverability of the carrying value of the Company’s inventory. As future events and their effects cannot be determined with precision, actual results may differ significantly from these estimates. The full extent to which the COVID-19 pandemic will directly or indirectly impact the Company’s business, results of operations and financial condition, including revenue, expenses, manufacturing, research and development costs and employee-related compensation, will depend on future developments that are highly uncertain, including new information that may emerge concerning COVID-19 and the actions taken to mitigate the spread of or treat COVID-19, as well as the economic impact on local, regional, national and international customers and markets. Management has made estimates of the impact of COVID-19 within the Company’s consolidated financial statements and there may be changes to those estimates in future periods. Actual results may differ from these estimates. Short-Term Investments Short-term investments consisted of investments in corporate debt securities with a maturity of greater than three months when acquired. The Company classified these investments as available-for-sale securities. These investments were reported at fair value with the related unrealized gains and losses included in accumulated other comprehensive income (loss), a component of stockholders’ equity. The Company had no short-term investments as of June 30, 2020. Short-term investments at December 31, 2019 consisted of the following (in thousands): Estimated Amortization/ Unrealized Fair Cost Accretion Gains/(Losses) Value Corporate debt securities $ 9,284 $ 5 $ (4) $ 9,285 Revenue Recognition Under ASC Topic 606, Revenue from Contracts with Customers , an entity recognizes revenue when its customer obtains control of the promised good, in an amount that reflects the consideration that the entity expects to be entitled in exchange for those goods. The Company performs the following five steps to recognize revenue under ASC Topic 606: (i) identify the contract(s) with a customer, (ii) identify the performance obligations in the contract, (iii) determine the transaction price, (iv) allocate the transaction price to the performance obligations in the contract, and (v) recognize revenue when (or as) the entity satisfies a performance obligation. The Company only recognizes revenue when it is probable that it will collect the consideration to which it is entitled in exchange for the goods or services that will be transferred to the customer. A significant portion of the Company’s revenue is generated from product shipped to a customer or from consigned inventory maintained at hospitals. Revenue from the sale of consigned products is recognized when control is transferred to the customer, which occurs at the time the product is used in a surgical procedure. For product that is not held on consignment, the Company recognizes revenue when control transfers to the customer which occurs at the time the product is shipped or delivered. For all of the Company’s contracts, the only identified performance obligation is providing the product to the customer. Payment terms with customers do not exceed one year and, therefore, the Company does not account for a financing component in its arrangements. There are no incremental costs of obtaining a contract that would rise to or enhance an asset other than product costs, which are a component of inventory. The Company expenses incremental costs of obtaining a contract with a customer (e.g., sales commissions) when incurred as the period of benefit is less than one year. Fees charged to customers for shipping are recognized as revenue. The following table presents revenue disaggregated by our portfolio of products (in thousands): Three months ended June 30, Six months ended June 30, 2020 2019 2020 2019 OviTex $ 2,942 $ 3,212 $ 6,181 $ 6,518 OviTex PRS 565 91 1,052 91 Total revenue $ 3,507 $ 3,303 $ 7,233 $ 6,609 Sales outside of the United States are immaterial for both the three and six months ended June 30, 2020 and 2019. Fair value of financial instruments Fair value is the price that could be received to sell an asset or paid to transfer a liability in an orderly transaction among market participants. Fair value determination in accordance with applicable accounting guidance requires that a number of significant judgments are made. Additionally, fair value is used on a nonrecurring basis to evaluate assets for impairment or as required for disclosure purposes by applicable accounting guidance on disclosures about fair value of financial instruments. Depending on the nature of the assets and liabilities, various valuation techniques and assumptions are used when estimating fair value. The carrying amounts of certain of the Company’s financial instruments, including cash and cash equivalents, accounts receivable and other assets, and accounts payable are shown at cost, which approximates fair value due to the short‑term nature of these instruments. Due to the related‑party relationship of the credit facility (the “OrbiMed Credit Facility”) with OrbiMed Royalty Opportunities IP, LP (“OrbiMed”) (Note 5), it is impractical to determine the fair value of the debt. The Company follows the provisions of FASB ASC Topic 820, Fair Value Measurement , for financial assets and liabilities measured on a recurring basis. The guidance requires fair value measurements be classified and disclosed in one of the following three categories: · Level 1: Unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets or liabilities. · Level 2: Quoted prices in markets that are not active, or inputs which are observable, either directly or indirectly, for substantially the full term of the asset or liabilities. · Level 3: Prices or valuation techniques that require inputs that are both significant to the fair value measurement and unobservable (i.e., supported by little or no market activity). The following fair value hierarchy table presents information about each major category of the Company’s financial assets and liabilities measured at fair value on a recurring basis (in thousands): Fair value measurement at reporting date using Quoted prices in active markets Significant other Significant for identical observable unobservable assets inputs inputs (Level 1) (Level 2) (Level 3) June 30, 2020: Assets: Cash equivalents – money market fund $ 84,879 $ — $ — December 31, 2019: Assets: Cash equivalents – money market fund $ 34,918 $ — $ — Cash equivalents – corporate debt securities $ — $ 8,850 $ — Cash equivalents – government agency securities $ — $ 1,000 $ — Short-term investments – corporate debt securities $ — $ 9,285 $ — At June 30, 2019, preferred stock warrants were outstanding and were a level 3 measurement. A rollforward of the warrant liability is as follows (in thousands): January 1, 2019 $ 1,640 Change in fair value of warrants 38 June 30, 2019 $ 1,678 Net loss per share Basic and diluted net loss per common share is determined by dividing net loss attributable to common stockholders by the weighted‑average shares of common stock outstanding during the reporting period. The Company’s outstanding redeemable convertible preferred stock contractually entitled the holders of such shares to participate in distributions but contractually did not require the holders of such shares to participate in losses of the Company. Accordingly, in periods in which the Company reports a net loss attributable to common stockholders, diluted net loss per share attributable to common stockholders is the same as basic net loss per share attributable to common stockholders since dilutive shares are not assumed to have been issued if their effect is antidilutive. Therefore, the weighted‑average shares used to calculate both basic and diluted loss per share are the same. The following potentially dilutive securities have been excluded from the computation of diluted weighted‑average shares outstanding for the periods presented, as they would be antidilutive. Three and six months ended June 30, 2020 2019 Series A redeemable convertible preferred stock — 911,336 Series B redeemable convertible preferred stock — 2,980,387 Stock options (including shares subject to repurchase) 1,538,954 530,463 Series B redeemable convertible preferred stock warrants — 88,556 Common stock warrants 88,556 — Total 1,627,510 4,510,742 Amounts in the above table reflect the common stock equivalents of the noted instrument. Recently Issued Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02, Leases , which requires a lessee to record a right-of-use asset and a corresponding lease liability on the balance sheet for all leases with terms longer than 12 months. A modified retrospective transition approach is required, applying the new standard to all leases existing at the date of initial application. An entity may choose to use either (1) its effective date or (2) the beginning of the earliest comparative period presented in the consolidated financial statements as its date of initial application. If an entity chooses the second option, the transition requirements for existing leases also apply to leases entered into between the date of initial application and the effective date. The standard is effective for the Company beginning January 1, 2022, with early adoption permitted. The Company plans to adopt this standard on January 1, 2022 and is currently evaluating the expected impact that the standard could have on its consolidated financial statements and related disclosures. In June 2018, the FASB issued ASU No. 2018-07, Compensation—Stock Compensation (Topic 718) Improvements to Nonemployee Share-Based Payment Accounting . The amendments in this update expand the scope of Topic 718 to include stock-based payment transactions for acquiring goods and services from nonemployees. Under this ASU, an entity should apply the requirements of Topic 718 to nonemployee awards except for specific guidance on inputs to an option pricing model and the attribution of costs (i.e., the period of time over which stock-based payment awards vest and the pattern of cost recognition over that period). The guidance is effective for the Company beginning January 1, 2020, with early adoption permitted. The adoption of this guidance did not have any impact on the consolidated financial statements and related disclosures. In August 2018, the FASB issued ASU No. 2018-13, Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurements, which changes the fair value measurement disclosure requirements of ASC Topic 820. The goal of the ASU is to improve the effectiveness of ASC Topic 820's disclosure requirements. The standard is effective for the Company beginning January 1, 2020. The adoption of this guidance did not have any impact on the consolidated financial statements and related disclosures.

Accrued Expenses and Other Curr

Accrued Expenses and Other Current Liabilities	6 Months Ended
	Jun. 30, 2020
Accrued Expenses and Other Current Liabilities
Accrued Expenses and Other Current Liabilities	(4) Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities consisted of the following (in thousands): June 30, December 31, 2020 2019 Compensation and related benefits $ 1,092 $ 2,314 Interest 40 41 Third-party and professional fees 1,206 641 Research and development expenses — 35 Other 337 511 $ 2,675 $ 3,542

Long term Debt

Long term Debt	6 Months Ended
	Jun. 30, 2020
Long term Debt
Long term Debt	(5) Long‑term Debt Long‑term debt consisted of the following (in thousands): June 30, December 31, 2020 2019 OrbiMed Term Loan (related party) $ 30,000 $ 30,000 End of term charge 3,000 3,000 Unamortized end of term charge and issuance costs (2,476) (2,757) Long-term debt with related party $ 30,524 $ 30,243 OrbiMed Term Loan (Related Party) Pursuant to the OrbiMed Credit Facility, which consists of up to $35.0 million in term loans (the “OrbiMed Term Loans”), the Company provided a first priority security interest in all existing and future acquired assets, excluding intellectual property and certain other assets, owned by the Company. The OrbiMed Term Loans consist of two tranches, a $30.0 million Tranche 1 (“Tranche 1”) and a $5.0 million Tranche 2 (“Tranche 2”). In November 2018, the Company borrowed $30.0 million of Tranche 1 and used a portion of the proceeds to repay the MidCap Credit Facility and will use the remaining proceeds to fund operations and capital expenditures. The Company elected not to borrow Tranche 2 prior to its expiration on December 31, 2019. The OrbiMed Credit Facility contains a negative pledge on intellectual property owned by the Company. The OrbiMed Credit Facility also contains customary indemnification obligations and customary events of default, including, among other things, (i) nonpayment, (ii) breach of warranty, (iii) nonperformance of covenants and obligations, (iv) default on other indebtedness, (v) judgments, (iv) change of control, (vii) bankruptcy and insolvency, (viii) impairment of security, (ix) key permit events, (x) key person event, (xi) regulatory matters, (xii) and key contracts. In addition, the Company must maintain a minimum cash balance of $2.0 million. In the event of default under the OrbiMed Credit Facility, the Company would be required to pay interest on principal and all other due and unpaid obligations at the current rate in effect plus 3%. The OrbiMed Term Loan matures on November 16, 2023 and bears interest at a rate equal to 7.75% plus the greater of one‑month LIBOR or 2.0%. At June 30, 2020, the interest rate was 9.75%. The Company is required to make 60 monthly interest payments beginning on November 30, 2018, with the entire principal payment due at maturity. The OrbiMed Term Loans have a prepayment penalty equal to 10.0% of the prepaid principal amount prior to the second anniversary of the Term Loans, 5.0% of the prepaid principal amount after the second anniversary but prior to the third anniversary and 2.5% of the prepaid principal amount after the third anniversary. The Company is also required to pay an exit fee at the time of maturity or prepayment event equal to 10.0% of all principal borrowings (the “End of Term Charge”) and an administration fee equal to $10,000 on the last day of each quarter until all obligations have been paid in full. In conjunction with the closing of the OrbiMed Term Loans, the Company incurred $0.3 million of third‑party and lender fees, which along with the End of Term charge of $3.0 million were recorded as debt issuance costs, and are being recognized as interest expense over the term of the loan using the effective‑interest method. Interest expense associated with the OrbiMed Credit Facility recorded for the six months ended June 30, 2020 was $1.8 million, of which $0.3 million was related to the amortization of debt issuance costs. Interest expense associated with the OrbiMed Credit Facility recorded for the six months ended June 30, 2019 was $1.8 million, of which $0.2 million was related to the amortization of debt issuance costs.

Stockholders_ Equity (Deficit)

Stockholders’ Equity (Deficit)	6 Months Ended
	Jun. 30, 2020
Stockholders’ Equity (Deficit)
Stockholders’ Equity (Deficit)	(6) Stockholders’ Equity (Deficit) In November 2019, the Company closed its IPO in which the Company issued and sold 4,398,700 shares of its common stock at a public offering price of $13.00 per share, including 398,700 shares of the Company’s common stock sold pursuant to the underwriters’ option to purchase additional shares. The Company received net proceeds of $50.6 million after deducting underwriting discounts, commissions and other offering expenses. In addition, immediately prior to the closing of the IPO, all of the Company’s outstanding shares of redeemable convertible preferred stock, including accrued dividends payable converted into an aggregate of 6,708,649 shares of common stock and the Company’s outstanding warrants to purchase shares of preferred stock were automatically converted into warrants to purchase an aggregate of 88,556 shares of common stock. In June 2020, the Company closed an underwritten public offering in which the Company issued and sold 3,000,000 shares of its common stock at a public offering price of $16.00 per share. The Company received net proceeds of $44.7 million after deducting underwriting discounts, commissions and other offering expenses. Warrants The Company had the following warrants outstanding to purchase common stock at June 30, 2020: Exercise Expiration Outstanding price dates Common stock warrants issued to MidCap 8,379 $ 28.65 Common stock warrants issued to note payable holders 15,712 28.65 Common stock warrants issued to convertible promissory note holders 64,465 $ 28.65 88,556

Stock-Based Compensation

Stock-Based Compensation	6 Months Ended
	Jun. 30, 2020
Stock-Based Compensation
Stock-Based Compensation	(7) Stock‑Based Compensation The Company has two equity incentive plans: the 2012 Stock Incentive Plan and the Amended and Restated 2019 Equity Incentive Plan. New awards can only be granted under the Amended and Restated 2019 Equity Incentive Plan (the “Plan”). At June 30, 2020, 753,175 shares were available for future issuances. The Plan provides for the grant of incentive stock options, nonqualified stock options, restricted stock awards, restricted stock units and/or stock appreciation rights to employees, directors, and other persons, as determined by the Company’s board of directors. The Company’s stock options vest based on the terms in each award agreement and generally vest over four years and have a term of 10 years. The Company estimates forfeitures that it expects will occur and adjusts expense for actual forfeitures in the periods they occur. The Company measures employee and nonemployee stock‑based awards at grant‑date fair value and records compensation expense on a straight‑line basis over the vesting period of the award. The Company recorded stock‑based compensation expense in the following expense categories of its accompanying consolidated statements of operations and comprehensive loss (in thousands): Three months ended June 30, Six months ended June 30, 2020 2019 2020 2019 Sales and marketing $ 172 $ 14 $ 333 $ 29 General and administrative 240 39 449 73 Research and development 82 6 161 17 Total stock‑based compensation $ 494 $ 59 $ 943 $ 119 The following table summarizes stock option activity for the Plan: Weighted average Weighted remaining Number of average exercise contractual term shares price per share (years) Outstanding at January 1, 2020 1,420,942 $ 10.35 Granted 148,566 15.14 Exercised (6,306) 6.97 Canceled/forfeited (24,573) 12.41 Outstanding at June 30, 2020 1,538,629 10.79 8.40 Vested and expected to vest at June 30, 2020 1,452,555 $ 10.70 8.35 Exercisable at June 30, 2020 416,174 $ 5.97 6.01 The 2012 Stock Incentive Plan and the Amended and Restated 2019 Equity Incentive Plan provide the holders of stock options an election to early exercise prior to vesting. The Company has the right, but not the obligation, to repurchase early exercised options without transferring any appreciation to the employee if the employee terminates employment before the end of the original vesting period. The repurchase price is the lesser of the original exercise price or the then fair value of the common stock. At June 30, 2020, $2,000 of proceeds from early exercised options are recognized as a current liability in other current liabilities in the accompanying consolidated balance sheet. The following table summarizes activity relating to early exercise of stock options: Number of shares Unvested balance at January 1, 2020 755 Vested (163) Forfeited (267) Unvested balance at June 30, 2020 325 The weighted average grant‑date fair value per share of options granted was $8.10 during the six months ended June 30, 2020. The aggregate intrinsic value of options exercised was $30,000 and $42,000 for the three and six months ended June 30, 2020, respectively. At June 30, 2020, the total unrecognized compensation expense related to unvested employee and nonemployee stock option awards was $5.9 million, which is expected to be recognized in expense over a weighted‑average period of approximately 2.94 years. Estimating Fair Value of Stock Options The fair value of each grant of stock options was determined by the Company using the methods and assumptions discussed below. Certain of these inputs are subjective and generally requires judgment to determine. Expected term – The expected term of stock options represents the weighted average period the stock options are expected to be outstanding. The Company uses the simplified method for estimating the expected term as provided by the Securities and Exchange Commission. The simplified method calculates the expected term as the average time to vesting and the contractual life of the options. Expected volatility – Due to the Company’s limited operating history and lack of company‑specific historical or implied volatility, the expected volatility assumption was determined by examining the historical volatilities of a group of industry peers whose share prices are publicly available. Risk‑free interest rate – The risk‑free rate assumption is based on the U.S. Treasury instruments, the terms of which were consistent with the expected term of the Company’s stock options. Expected dividend – The Company has not paid and does not intend to pay dividends. The fair value of each option was estimated on the date of grant using the weighted average assumptions in the table below: Six months ended June 30, 2020 Expected dividend yield — Expected volatility 58.3 % Risk‑free interest rate 0.95 % Expected term 5.93 Years

Related-Party Transactions

Related-Party Transactions	6 Months Ended
	Jun. 30, 2020
Related-Party Transactions
Related-Party Transactions	(8) Related‑Party Transactions On November 16, 2018, the Company entered into a senior secured term loan facility with OrbiMed, an entity affiliated with an owner of a material amount of the Company’s outstanding voting securities. The terms of the debt and related components are further described in more detail in Note 5.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2020
Summary of Significant Accounting Policies
Interim Financial Statements	Interim Financial Statements The accompanying unaudited interim consolidated financial statements have been prepared from the books and records of the Company in accordance with GAAP for interim financial information and Rule 10‑01 of Regulation S‑X promulgated by the SEC, which permits reduced disclosures for interim periods. All adjustments, consisting only of normal recurring adjustments, necessary for a fair presentation of the accompanying consolidated balance sheets and statements of operations and comprehensive loss, redeemable convertible preferred stock and stockholders’ equity (deficit) and cash flows have been made. Although these interim consolidated financial statements do not include all of the information and footnotes required for complete annual consolidated financial statements, management believes the disclosures are adequate to make the information presented not misleading. Unaudited interim results of operations and cash flows are not necessarily indicative of the results that may be expected for the full year. Unaudited interim consolidated financial statements and footnotes should be read in conjunction with the December 31, 2019 consolidated financial statements and footnotes included in the Annual Report.
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in 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 contingent liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the reporting period. The most significant judgments are employed in estimates used to determine the fair value of stock‑based awards issued and recoverability of the carrying value of the Company’s inventory. As future events and their effects cannot be determined with precision, actual results may differ significantly from these estimates. The full extent to which the COVID-19 pandemic will directly or indirectly impact the Company’s business, results of operations and financial condition, including revenue, expenses, manufacturing, research and development costs and employee-related compensation, will depend on future developments that are highly uncertain, including new information that may emerge concerning COVID-19 and the actions taken to mitigate the spread of or treat COVID-19, as well as the economic impact on local, regional, national and international customers and markets. Management has made estimates of the impact of COVID-19 within the Company’s consolidated financial statements and there may be changes to those estimates in future periods. Actual results may differ from these estimates.
Short-Term Investments	Short-Term Investments Short-term investments consisted of investments in corporate debt securities with a maturity of greater than three months when acquired. The Company classified these investments as available-for-sale securities. These investments were reported at fair value with the related unrealized gains and losses included in accumulated other comprehensive income (loss), a component of stockholders’ equity. The Company had no short-term investments as of June 30, 2020. Short-term investments at December 31, 2019 consisted of the following (in thousands): Estimated Amortization/ Unrealized Fair Cost Accretion Gains/(Losses) Value Corporate debt securities $ 9,284 $ 5 $ (4) $ 9,285
Revenue Recognition	Revenue Recognition Under ASC Topic 606, Revenue from Contracts with Customers , an entity recognizes revenue when its customer obtains control of the promised good, in an amount that reflects the consideration that the entity expects to be entitled in exchange for those goods. The Company performs the following five steps to recognize revenue under ASC Topic 606: (i) identify the contract(s) with a customer, (ii) identify the performance obligations in the contract, (iii) determine the transaction price, (iv) allocate the transaction price to the performance obligations in the contract, and (v) recognize revenue when (or as) the entity satisfies a performance obligation. The Company only recognizes revenue when it is probable that it will collect the consideration to which it is entitled in exchange for the goods or services that will be transferred to the customer. A significant portion of the Company’s revenue is generated from product shipped to a customer or from consigned inventory maintained at hospitals. Revenue from the sale of consigned products is recognized when control is transferred to the customer, which occurs at the time the product is used in a surgical procedure. For product that is not held on consignment, the Company recognizes revenue when control transfers to the customer which occurs at the time the product is shipped or delivered. For all of the Company’s contracts, the only identified performance obligation is providing the product to the customer. Payment terms with customers do not exceed one year and, therefore, the Company does not account for a financing component in its arrangements. There are no incremental costs of obtaining a contract that would rise to or enhance an asset other than product costs, which are a component of inventory. The Company expenses incremental costs of obtaining a contract with a customer (e.g., sales commissions) when incurred as the period of benefit is less than one year. Fees charged to customers for shipping are recognized as revenue. The following table presents revenue disaggregated by our portfolio of products (in thousands): Three months ended June 30, Six months ended June 30, 2020 2019 2020 2019 OviTex $ 2,942 $ 3,212 $ 6,181 $ 6,518 OviTex PRS 565 91 1,052 91 Total revenue $ 3,507 $ 3,303 $ 7,233 $ 6,609 Sales outside of the United States are immaterial for both the three and six months ended June 30, 2020 and 2019.
Fair value of financial instruments	Fair value of financial instruments Fair value is the price that could be received to sell an asset or paid to transfer a liability in an orderly transaction among market participants. Fair value determination in accordance with applicable accounting guidance requires that a number of significant judgments are made. Additionally, fair value is used on a nonrecurring basis to evaluate assets for impairment or as required for disclosure purposes by applicable accounting guidance on disclosures about fair value of financial instruments. Depending on the nature of the assets and liabilities, various valuation techniques and assumptions are used when estimating fair value. The carrying amounts of certain of the Company’s financial instruments, including cash and cash equivalents, accounts receivable and other assets, and accounts payable are shown at cost, which approximates fair value due to the short‑term nature of these instruments. Due to the related‑party relationship of the credit facility (the “OrbiMed Credit Facility”) with OrbiMed Royalty Opportunities IP, LP (“OrbiMed”) (Note 5), it is impractical to determine the fair value of the debt. The Company follows the provisions of FASB ASC Topic 820, Fair Value Measurement , for financial assets and liabilities measured on a recurring basis. The guidance requires fair value measurements be classified and disclosed in one of the following three categories: · Level 1: Unadjusted quoted prices in active markets that are accessible at the measurement date for identical, unrestricted assets or liabilities. · Level 2: Quoted prices in markets that are not active, or inputs which are observable, either directly or indirectly, for substantially the full term of the asset or liabilities. · Level 3: Prices or valuation techniques that require inputs that are both significant to the fair value measurement and unobservable (i.e., supported by little or no market activity). The following fair value hierarchy table presents information about each major category of the Company’s financial assets and liabilities measured at fair value on a recurring basis (in thousands): Fair value measurement at reporting date using Quoted prices in active markets Significant other Significant for identical observable unobservable assets inputs inputs (Level 1) (Level 2) (Level 3) June 30, 2020: Assets: Cash equivalents – money market fund $ 84,879 $ — $ — December 31, 2019: Assets: Cash equivalents – money market fund $ 34,918 $ — $ — Cash equivalents – corporate debt securities $ — $ 8,850 $ — Cash equivalents – government agency securities $ — $ 1,000 $ — Short-term investments – corporate debt securities $ — $ 9,285 $ — At June 30, 2019, preferred stock warrants were outstanding and were a level 3 measurement. A rollforward of the warrant liability is as follows (in thousands): January 1, 2019 $ 1,640 Change in fair value of warrants 38 June 30, 2019 $ 1,678
Net loss per share	Net loss per share Basic and diluted net loss per common share is determined by dividing net loss attributable to common stockholders by the weighted‑average shares of common stock outstanding during the reporting period. The Company’s outstanding redeemable convertible preferred stock contractually entitled the holders of such shares to participate in distributions but contractually did not require the holders of such shares to participate in losses of the Company. Accordingly, in periods in which the Company reports a net loss attributable to common stockholders, diluted net loss per share attributable to common stockholders is the same as basic net loss per share attributable to common stockholders since dilutive shares are not assumed to have been issued if their effect is antidilutive. Therefore, the weighted‑average shares used to calculate both basic and diluted loss per share are the same. The following potentially dilutive securities have been excluded from the computation of diluted weighted‑average shares outstanding for the periods presented, as they would be antidilutive. Three and six months ended June 30, 2020 2019 Series A redeemable convertible preferred stock — 911,336 Series B redeemable convertible preferred stock — 2,980,387 Stock options (including shares subject to repurchase) 1,538,954 530,463 Series B redeemable convertible preferred stock warrants — 88,556 Common stock warrants 88,556 — Total 1,627,510 4,510,742 Amounts in the above table reflect the common stock equivalents of the noted instrument.
Recently Issued Accounting Pronouncement	Recently Issued Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02, Leases , which requires a lessee to record a right-of-use asset and a corresponding lease liability on the balance sheet for all leases with terms longer than 12 months. A modified retrospective transition approach is required, applying the new standard to all leases existing at the date of initial application. An entity may choose to use either (1) its effective date or (2) the beginning of the earliest comparative period presented in the consolidated financial statements as its date of initial application. If an entity chooses the second option, the transition requirements for existing leases also apply to leases entered into between the date of initial application and the effective date. The standard is effective for the Company beginning January 1, 2022, with early adoption permitted. The Company plans to adopt this standard on January 1, 2022 and is currently evaluating the expected impact that the standard could have on its consolidated financial statements and related disclosures. In June 2018, the FASB issued ASU No. 2018-07, Compensation—Stock Compensation (Topic 718) Improvements to Nonemployee Share-Based Payment Accounting . The amendments in this update expand the scope of Topic 718 to include stock-based payment transactions for acquiring goods and services from nonemployees. Under this ASU, an entity should apply the requirements of Topic 718 to nonemployee awards except for specific guidance on inputs to an option pricing model and the attribution of costs (i.e., the period of time over which stock-based payment awards vest and the pattern of cost recognition over that period). The guidance is effective for the Company beginning January 1, 2020, with early adoption permitted. The adoption of this guidance did not have any impact on the consolidated financial statements and related disclosures. In August 2018, the FASB issued ASU No. 2018-13, Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurements, which changes the fair value measurement disclosure requirements of ASC Topic 820. The goal of the ASU is to improve the effectiveness of ASC Topic 820's disclosure requirements. The standard is effective for the Company beginning January 1, 2020. The adoption of this guidance did not have any impact on the consolidated financial statements and related disclosures

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2020
Summary of Significant Accounting Policies
Schedule Of Cash And Cash Equivalents And Short Term Investments	Short-term investments at December 31, 2019 consisted of the following (in thousands): Estimated Amortization/ Unrealized Fair Cost Accretion Gains/(Losses) Value Corporate debt securities $ 9,284 $ 5 $ (4) $ 9,285
Disaggregation of Revenue	The following table presents revenue disaggregated by our portfolio of products (in thousands): Three months ended June 30, Six months ended June 30, 2020 2019 2020 2019 OviTex $ 2,942 $ 3,212 $ 6,181 $ 6,518 OviTex PRS 565 91 1,052 91 Total revenue $ 3,507 $ 3,303 $ 7,233 $ 6,609
Schedule of fair value of assets and liabilities measured on recurring basis	The following fair value hierarchy table presents information about each major category of the Company’s financial assets and liabilities measured at fair value on a recurring basis (in thousands): Fair value measurement at reporting date using Quoted prices in active markets Significant other Significant for identical observable unobservable assets inputs inputs (Level 1) (Level 2) (Level 3) June 30, 2020: Assets: Cash equivalents – money market fund $ 84,879 $ — $ — December 31, 2019: Assets: Cash equivalents – money market fund $ 34,918 $ — $ — Cash equivalents – corporate debt securities $ — $ 8,850 $ — Cash equivalents – government agency securities $ — $ 1,000 $ — Short-term investments – corporate debt securities $ — $ 9,285 $ —
Schedule of warrant liability	At June 30, 2019, preferred stock warrants were outstanding and were a level 3 measurement. A rollforward of the warrant liability is as follows (in thousands): January 1, 2019 $ 1,640 Change in fair value of warrants 38 June 30, 2019 $ 1,678
Schedule of dilutive securities excluded	Three and six months ended June 30, 2020 2019 Series A redeemable convertible preferred stock — 911,336 Series B redeemable convertible preferred stock — 2,980,387 Stock options (including shares subject to repurchase) 1,538,954 530,463 Series B redeemable convertible preferred stock warrants — 88,556 Common stock warrants 88,556 — Total 1,627,510 4,510,742

Accrued Expenses and Other Cu_2

Accrued Expenses and Other Current Liabilities (Tables)	6 Months Ended
	Jun. 30, 2020
Accrued Expenses and Other Current Liabilities
Accrued Expenses	Accrued expenses and other current liabilities consisted of the following (in thousands): June 30, December 31, 2020 2019 Compensation and related benefits $ 1,092 $ 2,314 Interest 40 41 Third-party and professional fees 1,206 641 Research and development expenses — 35 Other 337 511 $ 2,675 $ 3,542

Long term Debt (Tables)

Long term Debt (Tables)	6 Months Ended
	Jun. 30, 2020
Long term Debt
Schedule of long term debt	Long‑term debt consisted of the following (in thousands): June 30, December 31, 2020 2019 OrbiMed Term Loan (related party) $ 30,000 $ 30,000 End of term charge 3,000 3,000 Unamortized end of term charge and issuance costs (2,476) (2,757) Long-term debt with related party $ 30,524 $ 30,243

Stockholders_ Equity (Deficit)

Stockholders’ Equity (Deficit) (Tables)	6 Months Ended
	Jun. 30, 2020
Stockholders’ Equity (Deficit)
Schedule of warrants outstanding to purchase common stock	Exercise Expiration Outstanding price dates Common stock warrants issued to MidCap 8,379 $ 28.65 Common stock warrants issued to note payable holders 15,712 28.65 Common stock warrants issued to convertible promissory note holders 64,465 $ 28.65 88,556

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2020
Stock-Based Compensation
Schedule of stock based compensation expense categories in statement of operations	The Company recorded stock‑based compensation expense in the following expense categories of its accompanying consolidated statements of operations and comprehensive loss (in thousands): Three months ended June 30, Six months ended June 30, 2020 2019 2020 2019 Sales and marketing $ 172 $ 14 $ 333 $ 29 General and administrative 240 39 449 73 Research and development 82 6 161 17 Total stock‑based compensation $ 494 $ 59 $ 943 $ 119
Schedule of stock option activity	Weighted average Weighted remaining Number of average exercise contractual term shares price per share (years) Outstanding at January 1, 2020 1,420,942 $ 10.35 Granted 148,566 15.14 Exercised (6,306) 6.97 Canceled/forfeited (24,573) 12.41 Outstanding at June 30, 2020 1,538,629 10.79 8.40 Vested and expected to vest at June 30, 2020 1,452,555 $ 10.70 8.35 Exercisable at June 30, 2020 416,174 $ 5.97 6.01
Schedule of activity relating to early exercise of stock options	Number of shares Unvested balance at January 1, 2020 755 Vested (163) Forfeited (267) Unvested balance at June 30, 2020 325
Schedule of weighted average assumptions	Six months ended June 30, 2020 Expected dividend yield — Expected volatility 58.3 % Risk‑free interest rate 0.95 % Expected term 5.93 Years

Risks and Liquidity (Details)

Risks and Liquidity (Details) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended
	Jun. 30, 2020	Nov. 30, 2019	Dec. 31, 2019
Unusual Risk or Uncertainty [Line Items]
Accumulated deficit	$ (181,160)		$ (167,859)
Received net proceeds of after deducting underwriting discounts, commissions and other offering expenses		$ 50,600
IPO
Unusual Risk or Uncertainty [Line Items]
Stock Issued During Period, Shares, New Issues		4,398,700
Shares Issued, Price Per Share		$ 13
Over-Allotment Option
Unusual Risk or Uncertainty [Line Items]
Stock Issued During Period, Shares, New Issues		398,700
Second Underwritten Public Offering [Member]
Unusual Risk or Uncertainty [Line Items]
Stock Issued During Period, Shares, New Issues	3,000,000
Shares Issued, Price Per Share	$ 16
Received net proceeds of after deducting underwriting discounts, commissions and other offering expenses	$ 44,700

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Short-Term Investments (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Cash and Cash Equivalents [Line Items]
Short-term Investments	$ 0	$ 9,285
Corporate debt securities
Cash and Cash Equivalents [Line Items]
Cost		9,284
Amortization/ Accretion		5
Unrealized Gains/(Losses)		(4)
Estimated Fair Value		$ 9,285

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Revenue Recognition (Details) $ in Millions	6 Months Ended
	Jun. 30, 2020USD ($)
Summary of Significant Accounting Policies
Incremental costs of obtaining a contract	$ 0

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Revenue Disaggregated (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Disaggregation of Revenue [Line Items]
Revenue	$ 3,507	$ 3,303	$ 7,233	$ 6,609
OviTex [Member]
Disaggregation of Revenue [Line Items]
Revenue	2,942	3,212	6,181	6,518
OviTex PRS [Member]
Disaggregation of Revenue [Line Items]
Revenue	$ 565	$ 91	$ 1,052	$ 91

Summary of Significant Accoun_7

Summary of Significant Accounting Policies - Fair value of financial instruments (Details) - Recurring - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Level 1 | Money market funds
Fair value of financial instruments
Cash equivalents	$ 84,879	$ 34,918
Level 2 | Corporate debt securities
Fair value of financial instruments
Cash equivalents		8,850
Short-term investment – corporate debt securities		9,285
Level 2 | Agency securities
Fair value of financial instruments
Cash equivalents		$ 1,000

Summary of Significant Accoun_8

Summary of Significant Accounting Policies - Warrant liability (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2019
Summary of Significant Accounting Policies
Beginning balance		$ 1,640
Change in fair value of warrants	$ 74	38
Ending balance	$ 1,678	$ 1,678

Summary of Significant Accoun_9

Summary of Significant Accounting Policies - Potentially dilutive securities (Details) - shares	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares	1,627,510	4,510,742
Stock Options
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares	1,538,954	530,463
Series A
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares		911,336
Series B
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares		2,980,387
Series B Redeemable Convertible Preferred Stock Warrants | Warrants
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares		88,556
Common Stock Warrants
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares	88,556

Accrued Expenses and Other Cu_3

Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Accrued Expenses and Other Current Liabilities
Compensation and related benefits	$ 1,092	$ 2,314
Interest	40	41
Professional fees	1,206	641
Research and development expenses		35
Other	337	511
Accrued Expenses, Total	$ 2,675	$ 3,542

Long term Debt - Schedule of lo

Long term Debt - Schedule of long term debt (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Debt
Long-term Debt	$ 30,524	$ 30,243
OrbiMed Term Loans (related party)
Debt
Long Term Debt	30,000	30,000
End of term charge	3,000	3,000
Unamortized issuance costs	(2,476)	(2,757)
Long-term Debt	$ 30,524	$ 30,243

Long term Debt - OrbiMed Term L

Long term Debt - OrbiMed Term Loan (related party) (Details)	6 Months Ended
	Jun. 30, 2020USD ($)tranche	Jun. 30, 2019USD ($)	Nov. 30, 2018USD ($)
OrbiMed Term Loans (related party)
Debt
Number of Tranches | tranche	2
Minimum Cash Balance	$ 2,000,000
Interest due to unpaid obligation	3.00%
Interest Rate (as a percent)	9.75%		7.75%
Number of Installment	60 months
Exit fee (as a percent)	10.00%
Administration Fees	$ 10,000
Debt issuance costs	300,000
Interest Expenses	1,800,000	$ 1,800,000
End of term charge	3,000,000
Amortization of debt issuance costs	$ 300,000	$ 200,000
OrbiMed Term Loans (related party) | Prior to second anniversary
Debt
Percentage of prepayment penalty on prepaid principal amount	10.00%
OrbiMed Term Loans (related party) | After second anniversary but prior to third anniversary
Debt
Percentage of prepayment penalty on prepaid principal amount	5.00%
OrbiMed Term Loans (related party) | After third anniversary
Debt
Percentage of prepayment penalty on prepaid principal amount	2.50%
OrbiMed Term Loans (related party) | LIBOR
Debt
Variable Interest Rate (as a percent)	2.00%
OrbiMed Term Loans (related party) | Maximum
Debt
Debt Amount	$ 35,000,000
Tranche One
Debt
Debt Amount	30,000,000		$ 30,000,000
Tranche Two
Debt
Debt Amount	$ 5,000,000

Stockholders_ Equity (Deficit_2

Stockholders’ Equity (Deficit) - IPO (Details) - USD ($) $ / shares in Units, $ in Millions	1 Months Ended
	Jun. 30, 2020	Nov. 30, 2019
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Received net proceeds of after deducting underwriting discounts, commissions and other offering expenses		$ 50.6
IPO
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Stock Issued During Period, Shares, New Issues		4,398,700
Shares Issued, Price Per Share		$ 13
Over-Allotment Option
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Stock Issued During Period, Shares, New Issues		398,700
Second Underwritten Public Offering [Member]
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Stock Issued During Period, Shares, New Issues	3,000,000
Shares Issued, Price Per Share	$ 16
Received net proceeds of after deducting underwriting discounts, commissions and other offering expenses	$ 44.7
Convertible Preferred Stock | IPO
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Aggregate of common stock		6,708,649
Warrants | IPO
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Aggregate of common stock		88,556

Stockholders_ Equity (Deficit_3

Stockholders’ Equity (Deficit) - Warrants outstanding (Details)	Jun. 30, 2020$ / sharesshares
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Warrants outstanding	88,556
MidCap Credit Facility | Warrants
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Warrants outstanding	8,379
warrants exercise price | $ / shares	$ 28.65
Notes payable | Warrants
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Warrants outstanding	15,712
warrants exercise price | $ / shares	$ 28.65
Convertible promissory notes | Warrants
Redeemable Convertible Preferred Stock and Stockholders’ Deficit
Warrants outstanding	64,465
warrants exercise price | $ / shares	$ 28.65

Stock-Based Compensation - Expe

Stock-Based Compensation - Expenses (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Stock-Based Compensation
Total stock-based compensation	$ 494	$ 59	$ 943	$ 119
Sales and marketing
Stock-Based Compensation
Total stock-based compensation	172	14	333	29
General and administrative
Stock-Based Compensation
Total stock-based compensation	240	39	449	73
Research and development
Stock-Based Compensation
Total stock-based compensation	$ 82	$ 6	$ 161	$ 17

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock Option Activity (Details) - $ / shares	6 Months Ended
	Jun. 30, 2020
Number of shares
Balance at beginning of period	1,420,942
Granted	148,566
Exercised	(6,306)
Canceled/forfeited	(24,573)
Balance at end of period	1,538,629
Vested and expected to vest at end of period	1,452,555
Exercisable at end of period	416,174
Weighted average exercise price per share
Balance at beginning of period (in dollars per share)	$ 10.35
Granted ( in dollars per share)	15.14
Exercised (in dollars per share)	6.97
Canceled/forfeited (in dollars per share)	12.41
Balance at end of period (in dollars per share)	10.79
Vested and expected to vest at end of period (in dollars per share)	10.70
Exercisable at end of period (in dollars per share)	$ 5.97
Weighted average remaining contractual term
Weighted average remaining contractual term, outstanding	8 years 4 months 24 days
Weighted average remaining contractual term, Vested and expected to vest	8 years 4 months 6 days
Weighted average remaining contractual term, Exercisable	6 years 4 days

Stock-Based Compensation - Earl

Stock-Based Compensation - Early Exercise Of Stock Options (Details)	6 Months Ended
	Jun. 30, 2020shares
Stock-Based Compensation
Unvested balance at beginning of period	755
Vested	(163)
Forfeited	(267)
Unvested balance at end of period	325

Stock-Based Compensation - Weig

Stock-Based Compensation - Weighted average assumptions (Details)	6 Months Ended
	Jun. 30, 2020
Stock-Based Compensation
Expected volatility	58.30%
Risk-free interest rate	0.95%
Expected term	5 years 11 months 5 days

Stock-Based Compensation - Narr

Stock-Based Compensation - Narratives (Details)	3 Months Ended	6 Months Ended
	Jun. 30, 2020USD ($)shares	Jun. 30, 2020USD ($)$ / sharesshares
Stock-Based Compensation
Weighted Average Grant Date Fair Value per share | $ / shares		$ 8.10
Aggregate intrinsic value	$ 30,000	$ 42,000
2012 Stock Incentive Plan
Stock-Based Compensation
Unrecognized compensation expense	$ 5,900,000	$ 5,900,000
Weighted Average period for recognition of unrecognized expenses		2 years 11 months 9 days
2012 Stock Incentive Plan | Current Liability
Stock-Based Compensation
Proceeds from early exercise of option		$ 2,000
2019 Equity Incentive Plan
Stock-Based Compensation
Shares available for future issuance | shares	753,175	753,175
Vesting Period		4 years
Vesting Term		P10Y