TELA Bio (TELA) 10-Q 13 Aug 24 2024 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2024	Aug. 03, 2024
Document and Entity Information
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2024
Document Transition Report	false
Entity File Number	001-39130
Entity Registrant Name	TELA Bio, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	45-5320061
Entity Address, Address Line One	1 Great Valley Parkway, Suite 24
Entity Address, City or Town	Malvern
Entity Address, State or Province	PA
Entity Address, Postal Zip Code	19355
City Area Code	484
Local Phone Number	320-2930
Title of 12(b) Security	Common Stock, $0.001 par value per share
Trading Symbol	TELA
Security Exchange Name	NASDAQ
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		24,713,798
Entity Central Index Key	0001561921
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q2
Amendment Flag	false

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 26,496	$ 46,729
Accounts receivable, net of allowances of $303 and $416	9,097	9,737
Inventory	13,372	13,162
Prepaid expenses and other assets	2,144	2,098
Total current assets	51,109	71,726
Property and equipment, net	2,349	1,984
Intangible assets, net	1,929	2,119
Right-of-use assets	1,851	1,954
Other long-term assets	2,701
Restricted cash	265	265
Total assets	60,204	78,048
Current liabilities:
Accounts payable	2,314	1,667
Accrued expenses and other current liabilities	12,675	15,300
Total current liabilities	14,989	16,967
Long-term debt	40,817	40,515
Other long-term liabilities	1,528	1,685
Total liabilities	57,334	59,167
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; 24,653,939 and 24,494,675 shares issued and outstanding at March 31, 2024 and December 31, 2023, respectively	25	24
Additional paid-in capital	341,897	339,655
Accumulated other comprehensive income	98	91
Accumulated deficit	(339,150)	(320,889)
Total stockholders' equity	2,870	18,881
Total liabilities and stockholders' equity	$ 60,204	$ 78,048

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Consolidated Balance Sheets
Accounts receivable, Allowance	$ 298	$ 416
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)	24,675,832	24,494,675
Common stock, shares outstanding (in shares)	24,675,832	24,494,675

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Consolidated Statements of Operations and Comprehensive Loss
Revenue	$ 16,091	$ 14,494	$ 32,694	$ 26,403
Cost of revenue (excluding amortization of intangible assets)	4,923	4,198	10,095	8,114
Amortization of intangible assets	95	95	190	190
Gross profit	11,073	10,201	22,409	18,099
Operating expenses:
Sales and marketing	16,699	14,577	34,219	28,043
General and administrative	3,621	3,472	7,450	7,106
Research and development	2,323	2,514	4,716	4,566
Total operating expenses	22,643	20,563	46,385	39,715
Other operating income:
Gain on sale of product line			(7,580)
Loss from operations	(11,570)	(10,362)	(16,396)	(21,616)
Other expense:
Interest expense	(1,331)	(1,298)	(2,663)	(2,544)
Other income	301	870	798	1,343
Total other expense	(1,030)	(428)	(1,865)	(1,201)
Net loss	$ (12,600)	$ (10,790)	$ (18,261)	$ (22,817)
Net loss per common share, basic	$ (0.51)	$ (0.46)	$ (0.74)	$ (1.08)
Net loss per common share, diluted	$ (0.51)	$ (0.46)	$ (0.74)	$ (1.08)
Weighted average common shares outstanding, basic	24,663,234	23,239,262	24,621,310	21,223,639
Weighted average common shares outstanding, diluted	24,663,234	23,239,262	24,621,310	21,223,639
Comprehensive loss:
Net loss	$ (12,600)	$ (10,790)	$ (18,261)	$ (22,817)
Foreign currency translation adjustment	1	(36)	7	(66)
Comprehensive loss	$ (12,599)	$ (10,826)	$ (18,254)	$ (22,883)

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Common stock	Additional paid-in capital	Accumulated other comprehensive income	Accumulated deficit	Total
Balance at Beginning of period at Dec. 31, 2022	$ 19	$ 288,361	$ 150	$ (274,225)	$ 14,305
Balance at Beginning of period (in shares) at Dec. 31, 2022	19,165,027
Vesting of restricted stock units and exercise of stock options		100			100
Vesting of restricted stock units and exercise of stock options (in shares)	117,238
Shares withheld for employee taxes		(280)			(280)
Shares withheld for employee taxes (in shares)	(25,951)
Foreign currency translation adjustment			(66)		(66)
Stock-based compensation expense		2,422			2,422
Sale of common stock, net of underwriting discounts, commissions and offering costs	$ 5	46,336			46,341
Sale of common stock, net of underwriting discounts, commissions and offering costs (in shares)	5,219,190
Net loss				(22,817)	(22,817)
Balance at Ending period at Jun. 30, 2023	$ 24	336,939	84	(297,042)	40,005
Balance at Ending period (in shares) at Jun. 30, 2023	24,475,504
Balance at Beginning of period at Mar. 31, 2023	$ 19	289,254	120	(286,252)	3,141
Balance at Beginning of period (in shares) at Mar. 31, 2023	19,227,777
Vesting of restricted stock units and exercise of stock options		56			56
Vesting of restricted stock units and exercise of stock options (in shares)	28,650
Shares withheld for employee taxes		(1)			(1)
Shares withheld for employee taxes (in shares)	(113)
Foreign currency translation adjustment			(36)		(36)
Stock-based compensation expense		1,294			1,294
Sale of common stock, net of underwriting discounts, commissions and offering costs	$ 5	46,336			46,341
Sale of common stock, net of underwriting discounts, commissions and offering costs (in shares)	5,219,190
Net loss				(10,790)	(10,790)
Balance at Ending period at Jun. 30, 2023	$ 24	336,939	84	(297,042)	40,005
Balance at Ending period (in shares) at Jun. 30, 2023	24,475,504
Balance at Beginning of period at Dec. 31, 2023	$ 24	339,655	91	(320,889)	18,881
Balance at Beginning of period (in shares) at Dec. 31, 2023	24,494,675
Vesting of restricted stock units and exercise of stock options	$ 1	225			226
Vesting of restricted stock units and exercise of stock options (in shares)	202,565
Issuance of common stock under the employee stock purchase plan		164			164
Issuance of common stock under the employee stock purchase plan (in shares)	27,969
Shares withheld for employee taxes		(339)			(339)
Shares withheld for employee taxes (in shares)	(49,377)
Foreign currency translation adjustment			7		7
Stock-based compensation expense		2,192			2,192
Net loss				(18,261)	(18,261)
Balance at Ending period at Jun. 30, 2024	$ 25	341,897	98	(339,150)	2,870
Balance at Ending period (in shares) at Jun. 30, 2024	24,675,832
Balance at Beginning of period at Mar. 31, 2024	$ 25	340,812	97	(326,550)	14,384
Balance at Beginning of period (in shares) at Mar. 31, 2024	24,653,939
Vesting of restricted stock units and exercise of stock options		6			6
Vesting of restricted stock units and exercise of stock options (in shares)	24,332
Shares withheld for employee taxes		(11)			(11)
Shares withheld for employee taxes (in shares)	(2,439)
Foreign currency translation adjustment			1		1
Stock-based compensation expense		1,090			1,090
Net loss				(12,600)	(12,600)
Balance at Ending period at Jun. 30, 2024	$ 25	$ 341,897	$ 98	$ (339,150)	$ 2,870
Balance at Ending period (in shares) at Jun. 30, 2024	24,675,832

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash flows from operating activities:
Net loss	$ (18,261)	$ (22,817)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation expense	293	239
Noncash interest expense	302	296
Amortization of intangible assets	190	190
Net changes in operating lease ROU assets and liabilities	(47)	(22)
Inventory excess and obsolescence charge	908	704
Stock-based compensation expense	2,192	2,422
Gain on sale of product line	(7,580)
Change in operating assets and liabilities:
Accounts receivable, net	263	(1,219)
Inventory	(1,545)	(2,936)
Prepaid expenses and other current assets	253	107
Accounts payable	594	651
Accrued expenses and other current and long-term liabilities	(2,627)	(104)
Foreign currency translation loss	(16)	(349)
Net cash used in operating activities	(25,081)	(22,838)
Cash flows from investing activities:
Purchase of property and equipment	(603)	(272)
Proceeds from the sale of product line	5,366
Net cash provided by (used in) investing activities	4,763	(272)
Cash flows from financing activities:
Proceeds from sale of common stock, net of underwriting discounts, commissions and offering costs		46,354
Proceeds from exercise of stock options	226	100
Payment of withholding taxes related to stock-based compensation to employees	(339)	(280)
Proceeds from issuance of common stock under the employee stock purchase plan	164
Net cash provided by financing activities	51	46,174
Effect of exchange rate on cash and cash equivalents	34	183
Net (decrease) increase in cash and cash equivalents and restricted cash	(20,233)	23,247
Cash and cash equivalents and restricted cash, beginning of period	46,994	42,019
Cash and cash equivalents and restricted cash, end of period	26,761	65,266
Supplemental disclosure of cash flow information:
Cash paid during the period for interest	2,361	2,248
Supplemental disclosures of noncash investing and financing activities:
Offering costs in accounts payable and accrued expenses and other current liabilities		13
Property and equipment in accounts payable and accrued expenses and other current liabilities	$ 55	$ 49

Background

Background	6 Months Ended
	Jun. 30, 2024
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 a commercial-stage medical technology company focused on providing innovative soft-tissue reconstruction solutions that optimize clinical outcomes by prioritizing the preservation and restoration of the patient’s own anatomy. OviTex Reinforced Tissue Matrix (“OviTex”), the Company’s first portfolio of products, addresses unmet needs in hernia repair and abdominal wall reconstruction by combining the benefits of biologic matrices and polymer materials while minimizing their shortcomings, at a cost-effective price. OviTex PRS Reinforced Tissue Matrix (“OviTex PRS”), the Company’s second portfolio of products, addresses unmet needs in plastic and reconstructive surgery. 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, 2024
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 $339.2 million as of June 30, 2024. The Company anticipates incurring additional losses until such time, if ever, it can generate sufficient revenue from its products to cover its expenses. In March 2024, the Company sold its distribution rights for NIVIS Fibrillar Collagen Pack to MiMedx Group, Inc. in exchange for an initial $5.0 million payment and additional future payments aggregating between a minimum of $3.0 million and a maximum of $7.0 million based on net sales of NIVIS during the first two years following its launch by MiMedx Group, Inc. ​ The operations of the Company are subject to certain risks and uncertainties including, among others, the uncertainty of product development, the impact of macroeconomic conditions, including any lingering effects of the COVID-19 pandemic or other public health crises, general economic uncertainty, including as a result of inflationary pressures and the measures undertaken by various governments to address them, banking instability, monetary policy changes, geopolitical factors such as the ongoing Russia-Ukraine conflict, the current conflict in Israel and Gaza (including any escalation or expansion) and increasing tensions between China and Taiwan, cybersecurity events affecting or disrupting normal hospital operations, 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, 2024
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 consolidated financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023. Any reference in these notes to applicable guidance is meant to refer to generally accepted accounting principles (“GAAP”) in the U.S. 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 Securities and Exchange Commission (“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, stockholders’ equity 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. The unaudited interim results of operations and cash flows are not necessarily indicative of the results that may be expected for the full year. The unaudited interim consolidated financial statements and footnotes should be read in conjunction with the consolidated financial statements and footnotes included in the Annual Report on Form 10-K for the year ended December 31, 2023. 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 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. Revenue Recognition Under ASC Topic 606, Revenue from Contracts with Customers A significant portion of the Company’s revenue is generated from product shipped to a customer or from consigned inventory maintained at hospitals or other surgical facilities. 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 customer contracts, the only identified performance obligation is providing the product to the customer. Revenue is recognized at the estimated net sales price, which includes estimates of variable consideration. The Company enters into contracts with certain third-party payors for the payment of rebates with respect to the utilization of its products. These rebates are based on contractual percentages. The Company estimates and records these rebates in the same period the related revenue is recognized, resulting in a reduction of product revenue. Payment terms with customers do not exceed one year and, therefore, the Company does not account for a financing component in these 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 the Company’s portfolio of products (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ ​ 2024 ​ 2023 ​ 2024 ​ 2023 OviTex ​ $ 11,124 ​ $ 10,058 ​ $ 21,659 ​ $ 18,081 OviTex PRS ​ ​ 4,796 ​ ​ 4,390 ​ ​ 10,741 ​ ​ 8,251 Other ​ ​ 171 ​ ​ 46 ​ ​ 294 ​ ​ 71 Total revenue ​ $ 16,091 ​ $ 14,494 ​ $ 32,694 ​ $ 26,403 ​ Sales outside of the U.S. were $2.4 million and $1.5 million, respectively, for the three months ended June 30, 2024 and 2023 and $4.7 million and $2.5 million, respectively, for the six months ended June 30, 2024 and 2023. 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, other assets, and accounts payable are shown at cost, which approximates fair value due to the short-term nature of these instruments. The carrying amounts of the Company’s Credit and Security Agreement approximates fair value due to its variable interest rate. The Company follows the provisions of ASC Topic 820, Fair Value Measurement ● 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, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash equivalents – money market fund ​ $ 24,498 ​ $ — ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash equivalents – money market fund ​ $ 41,561 ​ $ — ​ $ — ​ Net Loss per Common Share Basic and diluted net loss per common share is determined by dividing net loss by the weighted-average shares of common stock outstanding during the reporting period. In periods in which the Company reports a net loss, diluted net loss per share is the same as basic net loss per share 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 net 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. ​ ​ ​ ​ ​ ​ ​ ​ Six months ended June 30, ​ ​ 2024 ​ 2023 Stock options ​ 2,239,140 2,218,832 Unvested restricted stock units ​ 991,391 ​ 781,011 Common stock warrants ​ 88,556 ​ 88,556 Total 3,319,087 3,088,399 ​ Recently Issued Accounting Pronouncements The Company is an emerging growth company, as defined in the Jumpstart Our Business Startups Act of 2012 (the “JOBS Act”). Under the JOBS Act, emerging growth companies can delay adopting new or revised accounting standards issued subsequent to the enactment of the JOBS Act, until such time as those standards apply to private companies. The Company has elected to use this extended transition period for complying with new or revised accounting standards that have different effective dates for public and private companies until the earlier of the date that it (i) is no longer an emerging growth company or (ii) affirmatively and irrevocably opts out of the extended transition period provided in the JOBS Act. As a result, these consolidated financial statements may not be comparable to companies that comply with the new or revised accounting pronouncements as of public company effective dates. In August 2020, the FASB issued ASU No. 2020-06, Debt with Conversion and Other Options and Derivatives and Hedging - Contracts in Entity’s Own Equity (“ . In November 2023, the FASB issued ASU 2023-07, Improvements to Reportable Segment Disclosures ​ In December 2023, the FASB issued ASU 2023-09, Improvements to Income Tax Disclosures some categories if the items meet a quantitative threshold. This guidance is effective for annual periods beginning after December 15, 2024, and should be applied prospectively, but entities have the option to apply it retrospectively for each period presented. Early adoption is permitted for annual financial statements that have not yet been issued or made available for issuance. The Company is currently evaluating the expected impact that the standard could have on its consolidated financial statements and related disclosures.

Accrued Expenses and Other Curr

Accrued Expenses and Other Current Liabilities	6 Months Ended
	Jun. 30, 2024
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, ​ 2024 2023 Compensation and related benefits ​ $ 6,609 ​ $ 9,216 Third-party and professional fees ​ 2,685 ​ 2,828 Amounts due to contract manufacturer ​ ​ 1,945 ​ ​ 2,024 Current portion of operating lease liabilities ​ ​ 571 ​ ​ 565 Research and development expenses ​ ​ 99 ​ ​ 140 Other ​ 766 ​ 527 Total accrued expenses and other current liabilities ​ $ 12,675 ​ $ 15,300 ​

Long-term Debt

Long-term Debt	6 Months Ended
	Jun. 30, 2024
Debt
Debt	(5) Long-term Debt Long-term debt consisted of the following (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ June 30, ​ December 31, ​ 2024 2023 MidCap term loan ​ $ 40,000 ​ $ 40,000 End of term charge ​ 2,000 ​ 2,000 Unamortized end of term charge and issuance costs ​ (1,183) ​ (1,485) Long-term debt ​ $ 40,817 ​ $ 40,515 ​ MidCap Term Loan On May 26, 2022, the Company entered into the Credit and Security Agreement (the “MidCap Credit Agreement”) with MidCap Financial Trust, as agent, and certain lender parties thereto. The MidCap Credit Agreement consists of $40.0 million in a term loan. Upon closing, the Company used a portion of the proceeds to repay borrowings under a previous credit facility and intends to use the remaining proceeds to fund operations and other general corporate purposes. ​ Pursuant to the MidCap Credit Agreement, the Company provided a first priority security interest in all existing and future acquired assets, including intellectual property, owned by the Company. The MidCap Credit Agreement contains certain covenants that limit the Company’s ability to engage in certain transactions that may be in the Company’s long-term best interests, including the incurrence of additional indebtedness, effecting certain corporate changes, making certain investments, acquisitions or dispositions and paying dividends. ​ The MidCap Credit Agreement also contains customary indemnification obligations and customary events of default, including, among other things, (i) non-payment, (ii) breach of warranty, (iii) non-performance of covenants and obligations, (iv) default on other indebtedness, (v) judgments, (vi) change of control, (vii) bankruptcy and insolvency, (viii) impairment of security, (ix) key permit events, (x) termination of a pension plan, (xi) regulatory matters, (xii) material adverse effect and (xiii) breach of material contracts. ​ In addition, the Company must maintain minimum net revenue levels tested quarterly. In the event of default under the MidCap Credit Agreement, the Company would be required to pay interest on principal and all other due and unpaid obligations at the current rate in effect plus 2%. ​ The MidCap term loan matures on May 1, 2027 and bears interest at a rate equal to 6.25% plus the greater of one-month Term SOFR ​ Subject to certain limitations, the MidCap term loan has a prepayment fee equal to 3.0% of the prepaid principal amount for the first year following the closing date of the MidCap term loan, 2.0% of the prepaid principal amount for the second year following the closing date and 1.0% of the prepaid principal amount for the third year following the closing date and thereafter. The Company is also required to pay an exit fee at the time of maturity or prepayment event equal to 5% of all principal borrowings (the “End of Term Charge”) (or in the event of a prepayment event, the amount of principal being prepaid). ​ Interest expense associated with the MidCap Credit Facility recorded for the three and six months ended June 30, 2024 was $1.3 million and $2.7 million, respectively, of which $0.2 million and $0.3 million, respectively, was related to the amortization of debt issuance costs. Interest expense associated with the MidCap Credit Facility recorded for the three and six months ended June 30, 2023 was $1.3 million and $2.5 million, respectively, of which $0.2 million and $0.3 million, respectively, was related to the amortization of debt issuance costs.

Stockholders' Equity

Stockholders' Equity	6 Months Ended
	Jun. 30, 2024
Stockholders' Equity
Stockholders' Equity	(6) Stockholders’ Equity In November 2023, the Company entered into an Equity Distribution Agreement (the “2023 Equity Agreement”) with Piper Sandler & Co, (“Piper”) in connection with the establishment of an at-the-market offering program under which the Company may sell shares of its common stock, from time to time through Piper as sales agent, in an initial amount of up to $50.0 million. The 2023 Equity Agreement superseded and replaced the Company’s previous Equity Distribution Agreement with Piper dated December 18, 2020 (the “2020 Equity Agreement”), which is no longer effective. No sales were made under the 2023 Equity Agreement or the 2020 Equity Agreement during the six months ended June 30, 2024 or 2023. Warrants The Company had the following warrants outstanding to purchase common stock at June 30, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Exercise ​ Expiration ​ Outstanding ​ price dates Common stock warrants 8,379 ​ $ 28.65 2028 Common stock warrants 80,177 ​ 28.65 2027 ​ 88,556 ​ ​ ​ ​ ​ ​

Sale of Product Line

Sale of Product Line	6 Months Ended
	Jun. 30, 2024
Sale of Product Line
Sale of Product Line	(7) Sale of Product Line In March 2024, the Company entered into an Asset Purchase Agreement (“APA”) with MiMedx Group, Inc. (“MDXG”) to sell certain assets (the “Transaction”) related to NIVIS Fibrillar Collagen Pack Device (“NIVIS”). These assets mainly included the Company’s existing inventory of NIVIS, with a net carrying value of $0.8 million, and certain intellectual property rights to sell NIVIS, with no carrying value. MDXG assumed the Company’s existing supply agreements, including the minimum obligations for NIVIS that the Company entered into in 2022 ahead of the initial sales of NIVIS. In exchange for entering into the Transaction, the Company received an initial $5.0 million upfront payment and is entitled to receive future revenue-sharing payments based on the net sales of NIVIS during the first two years following its launch by MDXG, which revenue-sharing payments would range from a minimum of $3.0 million to a maximum of $7.0 million in the aggregate. Any consideration in excess of $3.0 million up to $7.0 million is considered variable consideration that is fully constrained. The Company accounted for the Transaction as a sale of a nonfinancial asset group in accordance with ASC 610-20 and followed the principals of ASC 606 to determine the consideration of $8.4 million related to the Transaction. The Company transferred control of the nonfinancial asset group in March 2024 and recognized a gain of $7.6 million on the consolidated statement of operations and comprehensive loss during the three months ended March 31, 2024. Additionally, the Company recorded the minimum revenue-share payment of $3.0 million as a receivable at June 30, 2024, with $0.3 million representing the current portion in prepaid expenses and other assets in the consolidated balance sheet and $2.7 million representing the long-term portion in other long-term assets in the consolidated balance sheet. At each reporting date, the Company assesses the constraint of variable consideration and records increases in the transaction price in the period that the estimate of variable consideration changes. For the three and six months ended June 30, 2024, no changes were made to the variable consideration.

Stock-Based Compensation

Stock-Based Compensation	6 Months Ended
	Jun. 30, 2024
Stock-Based Compensation
Stock-Based Compensation	(8) 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, 2024, 806,609 shares of common stock were available for future issuances under the Plan. The Plan is subject to an annual increase, subject to prior approval by the Company’s board of directors, equal to the lesser of (i) 432,442 shares, (ii) 4% of the shares outstanding on the last day of the immediately preceding fiscal year and (iii) such smaller number of shares as determined by the board of directors. 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 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 ratably over the vesting period of the award. The Company recorded stock-based compensation expense in the following expense categories of the accompanying consolidated statements of operations and comprehensive loss (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ 2024 2023 ​ 2024 ​ 2023 Sales and marketing ​ $ 302 ​ $ 467 ​ $ 675 ​ $ 868 General and administrative ​ ​ 624 ​ 637 ​ 1,197 ​ 1,191 Research and development ​ 164 ​ 190 ​ 320 ​ 363 Total stock‑based compensation ​ $ 1,090 ​ $ 1,294 ​ $ 2,192 ​ $ 2,422 ​ Stock Options 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 following table summarizes stock option activity: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ ​ ​ ​ average ​ ​ ​ ​ Weighted ​ remaining ​ ​ Number of ​ average exercise ​ contractual term ​ shares price per share (years) Outstanding at January 1, 2024 2,162,453 ​ $ 11.48 Granted 259,900 ​ 6.86 Exercised (38,431) ​ 5.88 Canceled/forfeited (144,782) ​ 11.07 Outstanding at June 30, 2024 2,239,140 ​ $ 11.07 6.11 Vested and expected to vest at June 30, 2024 2,202,926 ​ $ 11.10 6.06 Exercisable at June 30, 2024 1,667,647 ​ $ 11.60 5.24 ​ Included in outstanding options at June 30, 2024 were 334,907 stock options granted outside of the Plan. These grants were made pursuant to the Nasdaq inducement grant exception in accordance with Nasdaq listing rule 5635(c)(4). At June 30, 2024, the aggregate intrinsic value of both outstanding options and exercisable options was immaterial. The weighted average grant-date fair value per share of options granted was $4.67 during the six months ended June 30, 2024. The aggregate intrinsic value of options exercised was immaterial and $41,000 for the three and six months ended June 30, 2024, respectively. At June 30, 2024, the total unrecognized compensation expense related to unvested employee and nonemployee stock option awards was $3.2 million, which is expected to be recognized in expense over a weighted-average period of approximately 2.3 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 require judgment to determine. Expected term Expected volatility Risk-free interest rate Expected dividend The fair value of each option was estimated on the date of grant using the Black-Scholes option pricing model and the weighted average assumptions in the table below: ​ ​ ​ ​ ​ ​ ​ Six months ended ​ June 30, 2024 Expected dividend yield — ​ Expected volatility 73.2 % Risk‑free interest rate 4.29 % Expected term (in years) 6.14 ​ ​ Restricted Stock Units The Company has issued service-based and performance-based restricted stock units (“RSUs”). Vesting of the service-based RSUs is based on the terms in each award agreement and is generally over four years. Vesting of the performance-based RSUs is subject to continued service through 2026 and the achievement of certain performance milestones for fiscal year 2026. The amount of performance-based RSUs that will vest can range from 0% to 110% of the original number of RSUs granted. Expense for the performance-based RSUs is not recognized until the performance conditions are deemed probable of achievement. The Company has not recorded any expense related to the performance-based RSUs. The following table summarizes the service-based RSUs for the Plan: ​ ​ ​ ​ ​ ​ Number of ​ shares Outstanding at January 1, 2024 ​ 657,054 Granted ​ 393,425 Vested ​ (164,134) Canceled/forfeited ​ (111,454) Outstanding at June 30, 2024 ​ 774,891 ​ The following table summarizes the performance-based RSUs for the Plan: ​ ​ ​ ​ ​ ​ Number of ​ shares Outstanding at January 1, 2024 ​ 250,149 Granted ​ — Vested ​ — Canceled/forfeited ​ (33,649) Outstanding at June 30, 2024 ​ 216,500 ​ Included in outstanding RSUs at June 30, 2024 were 122,949 RSUs granted outside of the Plan. These grants were made pursuant to the Nasdaq inducement grant exception in accordance with Nasdaq listing rule 5635(c)(4). The weighted average grant-date fair value per RSU granted was $6.74 during the six months ended June 30, 2024. The aggregate intrinsic value of RSUs outstanding was $4.7 million at June 30, 2024. The total unrecognized compensation expense at June 30, 2024 related to RSUs was $5.3 million, which is expected to be recognized in expense over a weighted-average period of approximately 2.9 years. ​

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (12,600)	$ (10,790)	$ (18,261)	$ (22,817)

Insider Trading Arrangements

Insider Trading Arrangements	6 Months Ended
	Jun. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2024
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 Securities and Exchange Commission (“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, stockholders’ equity 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. The unaudited interim results of operations and cash flows are not necessarily indicative of the results that may be expected for the full year. The unaudited interim consolidated financial statements and footnotes should be read in conjunction with the consolidated financial statements and footnotes included in the Annual Report on Form 10-K for the year ended December 31, 2023.
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 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.
Revenue Recognition	Revenue Recognition Under ASC Topic 606, Revenue from Contracts with Customers A significant portion of the Company’s revenue is generated from product shipped to a customer or from consigned inventory maintained at hospitals or other surgical facilities. 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 customer contracts, the only identified performance obligation is providing the product to the customer. Revenue is recognized at the estimated net sales price, which includes estimates of variable consideration. The Company enters into contracts with certain third-party payors for the payment of rebates with respect to the utilization of its products. These rebates are based on contractual percentages. The Company estimates and records these rebates in the same period the related revenue is recognized, resulting in a reduction of product revenue. Payment terms with customers do not exceed one year and, therefore, the Company does not account for a financing component in these 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 the Company’s portfolio of products (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ ​ 2024 ​ 2023 ​ 2024 ​ 2023 OviTex ​ $ 11,124 ​ $ 10,058 ​ $ 21,659 ​ $ 18,081 OviTex PRS ​ ​ 4,796 ​ ​ 4,390 ​ ​ 10,741 ​ ​ 8,251 Other ​ ​ 171 ​ ​ 46 ​ ​ 294 ​ ​ 71 Total revenue ​ $ 16,091 ​ $ 14,494 ​ $ 32,694 ​ $ 26,403 ​ Sales outside of the U.S. were $2.4 million and $1.5 million, respectively, for the three months ended June 30, 2024 and 2023 and $4.7 million and $2.5 million, respectively, for the six months ended June 30, 2024 and 2023.
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, other assets, and accounts payable are shown at cost, which approximates fair value due to the short-term nature of these instruments. The carrying amounts of the Company’s Credit and Security Agreement approximates fair value due to its variable interest rate. The Company follows the provisions of ASC Topic 820, Fair Value Measurement ● 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, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash equivalents – money market fund ​ $ 24,498 ​ $ — ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash equivalents – money market fund ​ $ 41,561 ​ $ — ​ $ —
Net Loss per Common Share	Net Loss per Common Share Basic and diluted net loss per common share is determined by dividing net loss by the weighted-average shares of common stock outstanding during the reporting period. In periods in which the Company reports a net loss, diluted net loss per share is the same as basic net loss per share 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 net 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. ​ ​ ​ ​ ​ ​ ​ ​ Six months ended June 30, ​ ​ 2024 ​ 2023 Stock options ​ 2,239,140 2,218,832 Unvested restricted stock units ​ 991,391 ​ 781,011 Common stock warrants ​ 88,556 ​ 88,556 Total 3,319,087 3,088,399 ​
Recently Issued Accounting Pronouncements	Recently Issued Accounting Pronouncements The Company is an emerging growth company, as defined in the Jumpstart Our Business Startups Act of 2012 (the “JOBS Act”). Under the JOBS Act, emerging growth companies can delay adopting new or revised accounting standards issued subsequent to the enactment of the JOBS Act, until such time as those standards apply to private companies. The Company has elected to use this extended transition period for complying with new or revised accounting standards that have different effective dates for public and private companies until the earlier of the date that it (i) is no longer an emerging growth company or (ii) affirmatively and irrevocably opts out of the extended transition period provided in the JOBS Act. As a result, these consolidated financial statements may not be comparable to companies that comply with the new or revised accounting pronouncements as of public company effective dates. In August 2020, the FASB issued ASU No. 2020-06, Debt with Conversion and Other Options and Derivatives and Hedging - Contracts in Entity’s Own Equity (“ . In November 2023, the FASB issued ASU 2023-07, Improvements to Reportable Segment Disclosures ​ In December 2023, the FASB issued ASU 2023-09, Improvements to Income Tax Disclosures some categories if the items meet a quantitative threshold. This guidance is effective for annual periods beginning after December 15, 2024, and should be applied prospectively, but entities have the option to apply it retrospectively for each period presented. Early adoption is permitted for annual financial statements that have not yet been issued or made available for issuance. The Company is currently evaluating the expected impact that the standard could have on its consolidated financial statements and related disclosures.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2024
Summary of Significant Accounting Policies
Disaggregation of Revenue	The following table presents revenue disaggregated by the Company’s portfolio of products (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ ​ 2024 ​ 2023 ​ 2024 ​ 2023 OviTex ​ $ 11,124 ​ $ 10,058 ​ $ 21,659 ​ $ 18,081 OviTex PRS ​ ​ 4,796 ​ ​ 4,390 ​ ​ 10,741 ​ ​ 8,251 Other ​ ​ 171 ​ ​ 46 ​ ​ 294 ​ ​ 71 Total revenue ​ $ 16,091 ​ $ 14,494 ​ $ 32,694 ​ $ 26,403
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, 2024: ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash equivalents – money market fund ​ $ 24,498 ​ $ — ​ $ — ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ December 31, 2023: ​ ​ ​ ​ ​ ​ ​ ​ ​ Cash equivalents – money market fund ​ $ 41,561 ​ $ — ​ $ —
Schedule of dilutive securities excluded	​ ​ ​ ​ ​ ​ ​ ​ Six months ended June 30, ​ ​ 2024 ​ 2023 Stock options ​ 2,239,140 2,218,832 Unvested restricted stock units ​ 991,391 ​ 781,011 Common stock warrants ​ 88,556 ​ 88,556 Total 3,319,087 3,088,399

Accrued Expenses and Other Cu_2

Accrued Expenses and Other Current Liabilities (Tables)	6 Months Ended
	Jun. 30, 2024
Accrued Expenses and Other Current Liabilities
Schedule of Accrued Expenses and Other Current Liabilities	Accrued expenses and other current liabilities consisted of the following (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ June 30, ​ December 31, ​ 2024 2023 Compensation and related benefits ​ $ 6,609 ​ $ 9,216 Third-party and professional fees ​ 2,685 ​ 2,828 Amounts due to contract manufacturer ​ ​ 1,945 ​ ​ 2,024 Current portion of operating lease liabilities ​ ​ 571 ​ ​ 565 Research and development expenses ​ ​ 99 ​ ​ 140 Other ​ 766 ​ 527 Total accrued expenses and other current liabilities ​ $ 12,675 ​ $ 15,300 ​

Long-term Debt (Tables)

Long-term Debt (Tables)	6 Months Ended
	Jun. 30, 2024
Debt
Schedule of long term debt	Long-term debt consisted of the following (in thousands): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ June 30, ​ December 31, ​ 2024 2023 MidCap term loan ​ $ 40,000 ​ $ 40,000 End of term charge ​ 2,000 ​ 2,000 Unamortized end of term charge and issuance costs ​ (1,183) ​ (1,485) Long-term debt ​ $ 40,817 ​ $ 40,515

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2024
Stockholders' Equity
Schedule of warrants outstanding to purchase common stock	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Exercise ​ Expiration ​ Outstanding ​ price dates Common stock warrants 8,379 ​ $ 28.65 2028 Common stock warrants 80,177 ​ 28.65 2027 ​ 88,556 ​ ​ ​ ​ ​ ​

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2024
Stock-Based Compensation
Schedule of stock based compensation expense categories in statement of operations	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three months ended June 30, ​ Six months ended June 30, ​ 2024 2023 ​ 2024 ​ 2023 Sales and marketing ​ $ 302 ​ $ 467 ​ $ 675 ​ $ 868 General and administrative ​ ​ 624 ​ 637 ​ 1,197 ​ 1,191 Research and development ​ 164 ​ 190 ​ 320 ​ 363 Total stock‑based compensation ​ $ 1,090 ​ $ 1,294 ​ $ 2,192 ​ $ 2,422
Schedule of stock option activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ ​ ​ ​ average ​ ​ ​ ​ Weighted ​ remaining ​ ​ Number of ​ average exercise ​ contractual term ​ shares price per share (years) Outstanding at January 1, 2024 2,162,453 ​ $ 11.48 Granted 259,900 ​ 6.86 Exercised (38,431) ​ 5.88 Canceled/forfeited (144,782) ​ 11.07 Outstanding at June 30, 2024 2,239,140 ​ $ 11.07 6.11 Vested and expected to vest at June 30, 2024 2,202,926 ​ $ 11.10 6.06 Exercisable at June 30, 2024 1,667,647 ​ $ 11.60 5.24
Schedule of weighted average assumptions	​ ​ ​ ​ ​ ​ ​ Six months ended ​ June 30, 2024 Expected dividend yield — ​ Expected volatility 73.2 % Risk‑free interest rate 4.29 % Expected term (in years) 6.14 ​
Schedule of restricted stock units (RSUs)	​ ​ ​ ​ ​ ​ Number of ​ shares Outstanding at January 1, 2024 ​ 657,054 Granted ​ 393,425 Vested ​ (164,134) Canceled/forfeited ​ (111,454) Outstanding at June 30, 2024 ​ 774,891
Schedule of performance-based (RSUs)	​ ​ ​ ​ ​ ​ Number of ​ shares Outstanding at January 1, 2024 ​ 250,149 Granted ​ — Vested ​ — Canceled/forfeited ​ (33,649) Outstanding at June 30, 2024 ​ 216,500

Risks and Liquidity (Details)

Risks and Liquidity (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023
Unusual Risk or Uncertainty [Line Items]
Accumulated deficit	$ (339,150)		$ (320,889)
Proceeds from the sale of product line	5,366
Received net proceeds of after deducting underwriting discounts, commissions and other offering expenses		$ 46,354
MiMedx Group, Inc.
Unusual Risk or Uncertainty [Line Items]
Proceeds from the sale of product line	$ 5,000
Period of net sales considered for calculating additional future payment receivable	2 years
MiMedx Group, Inc. | Maximum
Unusual Risk or Uncertainty [Line Items]
Revenue sharing payments	$ 7,000
MiMedx Group, Inc. | Minimum
Unusual Risk or Uncertainty [Line Items]
Revenue sharing payments	$ 3,000

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Revenue Disaggregated (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Disaggregation of Revenue [Line Items]
Revenue	$ 16,091	$ 14,494	$ 32,694	$ 26,403
Incremental costs of obtaining a contract			0
Non-US [Member]
Disaggregation of Revenue [Line Items]
Revenue	2,400	1,500	4,700	2,500
OviTex
Disaggregation of Revenue [Line Items]
Revenue	11,124	10,058	21,659	18,081
OviTex PRS
Disaggregation of Revenue [Line Items]
Revenue	4,796	4,390	10,741	8,251
Other
Disaggregation of Revenue [Line Items]
Revenue	$ 171	$ 46	$ 294	$ 71

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Fair Value of Financial Instruments (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Recurring | Level 1 | Money market funds
Fair Value of Financial Instruments
Cash equivalents	$ 24,498	$ 41,561

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Net Loss per Common Share (Potentially dilutive securities) (Details) - shares	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares	3,319,087	3,088,399
Employee Stock Option
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares	2,239,140	2,218,832
Unvested restricted stock units
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares	991,391	781,011
Common Stock Warrants
Potentially dilutive securities
Potentially dilutive securities excluded from computation of diluted weighted average shares	88,556	88,556

Accrued Expenses and Other Cu_3

Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Accrued Expenses and Other Current Liabilities
Compensation and related benefits	$ 6,609	$ 9,216
Third-party and professional fees	2,685	2,828
Amounts due to contract manufacturer	1,945	2,024
Current portion of operating lease liabilities	$ 571	$ 565
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Total accrued expenses and other current liabilities	Total accrued expenses and other current liabilities
Research and development expenses	$ 99	$ 140
Other	766	527
Total accrued expenses and other current liabilities	$ 12,675	$ 15,300

Long-term Debt - Schedule of lo

Long-term Debt - Schedule of long term debt (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023	May 26, 2022
Long term Debt
End of term charge	$ 2,000	$ 2,000
Unamortized end of term charge and issuance costs	(1,183)	(1,485)
Long-term debt	40,817	40,515
MidCap term loan
Long term Debt
MidCap term loan	$ 40,000	$ 40,000	$ 40,000

Long-term Debt - MidCap Term Lo

Long-term Debt - MidCap Term Loan (Details) - MidCap term loan - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023	May 26, 2022
Long term Debt
Debt amount	$ 40,000		$ 40,000		$ 40,000	$ 40,000
Interest due to unpaid obligation			2%
Interest Rate (as a percent)	6.25%		6.25%
Variable Interest Rate (as a percent)			1%
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]			us-gaap:SecuredOvernightFinancingRateSofrOvernightIndexSwapRateMember
Interest-Only Period			36 months
Exit fee (as a percent)			5%
Interest expenses	$ 1,300	$ 1,300	$ 2,700	$ 2,500
Amortization of debt issuance costs	$ 200	$ 200	$ 300	$ 300
Maximum
Long term Debt
Extension for interest only payment period			48 months
Minimum
Long term Debt
Extension for interest only payment period			12 months
First year
Long term Debt
Percentage of prepayment penalty on prepaid principal amount			3%
Second year
Long term Debt
Percentage of prepayment penalty on prepaid principal amount			2%
Third year
Long term Debt
Percentage of prepayment penalty on prepaid principal amount			1%

Stockholders' Equity - Public S

Stockholders' Equity - Public Stock Offerings (Details) - USD ($) $ in Thousands	6 Months Ended	18 Months Ended
	Jun. 30, 2023	Jun. 30, 2024	Nov. 30, 2023
Stockholders' Equity
Received net proceeds of after deducting underwriting discounts, commissions and other offering expenses	$ 46,354
Equity Distribution Agreement
Stockholders' Equity
Common Stock Available Under ATM			$ 50,000
Value Of Shares Sold Under Equity Distribution Agreement		$ 0

Stockholders' Equity - Warrants

Stockholders' Equity - Warrants outstanding (Details)	6 Months Ended
	Jun. 30, 2024 $ / shares shares
Stockholders' Equity
Warrants outstanding	88,556
Common stock warrants expiring in 2028
Stockholders' Equity
Warrants outstanding	8,379
Warrants exercise price | $ / shares	$ 28.65
Expiration dates	2028
Common stock warrants expiring in 2027
Stockholders' Equity
Warrants outstanding	80,177
Warrants exercise price | $ / shares	$ 28.65
Expiration dates	2027

Sale of Product Line - Narrativ

Sale of Product Line - Narrative (Details) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2024
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from the sale of product line			$ 5,366,000
Gain on sale of product line			7,580,000
MiMedx Group, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from the sale of product line			5,000,000
Minimum | MiMedx Group, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Revenue sharing payments	$ 3,000,000		3,000,000
Maximum | MiMedx Group, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Revenue sharing payments	7,000,000		7,000,000
Transaction | MiMedx Group, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Amount minimum revenue share payments receivable	3,000,000		3,000,000
Amount minimum revenue share payments receivable current	300,000		300,000
Amount minimum revenue share payments receivable non-current	2,700,000		2,700,000
Variable Consideration	0		0
Transaction | Minimum | MiMedx Group, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Revenue sharing payments	3,000,000		3,000,000
Variable consideration	3,000,000		3,000,000
Transaction | Maximum | MiMedx Group, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Revenue sharing payments	7,000,000		7,000,000
Variable consideration	7,000,000		7,000,000
Transaction | Disposal Group, Disposed of by Sale, Not Discontinued Operations [Member] | MiMedx Group, Inc.
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Net carrying value	800,000		800,000
Carrying value	0		0
Proceeds from the sale of product line			5,000,000
Consideration determined	$ 8,400,000		$ 8,400,000
Gain on sale of product line		$ 7,600,000

Stock-Based Compensation - Narr

Stock-Based Compensation - Narratives (Details)	6 Months Ended
	Jun. 30, 2024 USD ($) item $ / shares shares
Stock-Based Compensation
Number of equity incentive plans | item	2
Employee Stock Option [Member]
Stock-Based Compensation
Inducement grants | shares	334,907
Weighted average grant date fair value, Options (per share) | $ / shares	$ 4.67
Aggregate intrinsic value of exercised options | $	$ 41,000
Unrecognized compensation expense | $	$ 3,200,000
Weighted average period for recognition of unrecognized expenses	2 years 3 months 18 days
Restricted stock units
Stock-Based Compensation
Inducement grants | shares	122,949
Unrecognized compensation expense | $	$ 5,300,000
Weighted average period for recognition of unrecognized expenses	2 years 10 months 24 days
Weighted average grant date fair value, Equity Instruments (per share) | $ / shares	$ 6.74
Aggregate intrinsic value | $	$ 4,700,000
Performance based restricted stock units | Minimum
Stock-Based Compensation
Vest Range	0%
Performance based restricted stock units | Maximum
Stock-Based Compensation
Vest Range	110%
Service based restricted stock unit
Stock-Based Compensation
Vesting period	4 years
2019 Equity Incentive Plan
Stock-Based Compensation
Shares available for future issuance | shares	806,609
Common Stock Capital Shares Reserved For Future Annual Issuance | shares	432,442
Potential common shares outstanding on the last day of the immediately preceding fiscal year	4%
2019 Equity Incentive Plan | Employee Stock Option [Member]
Stock-Based Compensation
Vesting period	4 years
Contractual term	10 years

Stock-Based Compensation - Expe

Stock-Based Compensation - Expenses (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Stock-Based Compensation
Total stock-based compensation	$ 1,090	$ 1,294	$ 2,192	$ 2,422
Sales and marketing
Stock-Based Compensation
Total stock-based compensation	302	467	675	868
General and administrative
Stock-Based Compensation
Total stock-based compensation	624	637	1,197	1,191
Research and development
Stock-Based Compensation
Total stock-based compensation	$ 164	$ 190	$ 320	$ 363

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock Option Activity (Details)	6 Months Ended
	Jun. 30, 2024 $ / shares shares
Number of shares
Balance at beginning of period | shares	2,162,453
Granted | shares	259,900
Exercised | shares	(38,431)
Canceled/forfeited | shares	(144,782)
Balance at end of period | shares	2,239,140
Vested and expected to vest at end of period | shares	2,202,926
Exercisable at end of period | shares	1,667,647
Weighted average exercise price per share
Balance at beginning of period (in dollars per share) | $ / shares	$ 11.48
Granted ( in dollars per share) | $ / shares	6.86
Exercised (in dollars per share) | $ / shares	5.88
Canceled/forfeited (in dollars per share) | $ / shares	11.07
Balance at end of period (in dollars per share) | $ / shares	11.07
Vested and expected to vest at end of period (in dollars per share) | $ / shares	11.10
Exercisable at end of period (in dollars per share) | $ / shares	$ 11.60
Weighted average remaining contractual term (years)
Weighted average remaining contractual term, outstanding	6 years 1 month 9 days
Weighted average remaining contractual term, Vested and expected to vest	6 years 21 days
Weighted average remaining contractual term, Exercisable	5 years 2 months 26 days

Stock-Based Compensation - Weig

Stock-Based Compensation - Weighted average assumptions (Details)	6 Months Ended
	Jun. 30, 2024
Stock-Based Compensation
Expected volatility	73.20%
Risk-free interest rate	4.29%
Expected term (in years)	6 years 1 month 20 days

Stock-Based Compensation - Rest

Stock-Based Compensation - Restricted Stock Units (Details)	6 Months Ended
	Jun. 30, 2024 shares
Service Based Restricted Stock Units [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Outstanding at beginning of period	657,054
Granted	393,425
Vested	(164,134)
Canceled/forfeited	(111,454)
Outstanding at end of period	774,891
Performance Based Restricted Stock Units [Member]
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Outstanding at beginning of period	250,149
Canceled/forfeited	(33,649)
Outstanding at end of period	216,500