0001376339-22-000058 | 10-Q | XBRL Viewer

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Cover - shares	3 Months Ended
Cover - shares	Mar. 31, 2022	Apr. 27, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2022
Document Transition Report	false
Entity File Number	001-35887
Entity Registrant Name	MIMEDX GROUP, INC.
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-2792552
Entity Address, Address Line One	1775 West Oak Commons Ct NE
Entity Address, City or Town	Marietta
Entity Address, State or Province	GA
Entity Address, Postal Zip Code	30062
City Area Code	770
Local Phone Number	651-9100
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	MDXG
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		113,352,746
Entity Central Index Key	0001376339
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 75,676	$ 87,083
Accounts receivable, net	37,674	40,353
Inventory	13,170	11,389
Prepaid Expense, Current	6,136	6,146
Income tax receivable	680	743
Other current assets	2,571	2,809
Total current assets	135,907	148,523
Property and equipment, net	8,759	9,165
Right of use asset	4,364	4,696
Goodwill	19,976	19,976
Intangible assets, net	5,265	5,383
Other assets	172	186
Total assets	174,443	187,929
Current liabilities:
Accounts payable	8,120	7,385
Accrued compensation	17,102	23,595
Accrued expenses	9,812	9,812
Other current liabilities	1,557	1,565
Total current liabilities	36,591	42,357
Long term debt, net	48,239	48,127
Other liabilities	4,553	4,869
Total liabilities	89,383	95,353
Commitments and contingencies (Note 13)
Convertible preferred stock Series B; $0.001 par value; 100,000 shares authorized, issued and outstanding at March 31, 2022 and December 31, 2021	92,494	92,494
Stockholders' (deficit) equity
Preferred stock Series A; $0.001 par value; 5,000,000 shares authorized, 0 issued and outstanding at March 31, 2022 and December 31, 2021	$ 0	$ 0
Common stock, shares issued (in shares)	113,525,178	112,703,926
Common stock, shares authorized (in shares)	187,500,000	187,500,000
Common stock; $0.001 par value; 187,500,000 shares authorized; 113,525,178 issued and 113,352,410 outstanding at March 31, 2022 and 112,703,926 issued and 111,925,216 outstanding at December 31, 2021	$ 114	$ 113
Additional paid-in capital	165,490	165,695
Treasury stock at cost; 172,768 shares at March 31, 2022 and 778,710 shares at December 31, 2021	(840)	(4,017)
Accumulated deficit	(172,198)	(161,709)
Total stockholders' (deficit) equity	(7,434)	82
Total liabilities, convertible preferred stock, and stockholders’ (deficit) equity	$ 174,443	$ 187,929

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2022	Dec. 31, 2021
LIABILITIES, CONVERTIBLE PREFERRED STOCK, AND STOCKHOLDERS’ (DEFICIT) EQUITY
Series B convertible preferred stock par value (in dollars per share)	$ 0.001	$ 0.001
Series B convertible preferred stock, shares authorized (in shares)	100,000	100,000
Series B convertible preferred stock, shares issued (in shares)	100,000	100,000
Series B convertible preferred stock, shares outstanding (in shares)	100,000	100,000
Stockholders' equity:
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	187,500,000	187,500,000
Common stock, shares issued (in shares)	113,525,178	112,703,926
Common stock, shares outstanding (in shares)	113,352,410	111,925,216
Treasury stock, shares (in shares)	172,768	778,710

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Income Statement [Abstract]
Net sales	$ 58,894	$ 59,967
Cost of sales	9,936	9,641
Gross profit	48,958	50,326
Operating expenses:
Selling, general and administrative	49,570	45,404
Research and development	5,964	4,339
Investigation, restatement and related	2,552	7,196
Amortization of intangible assets	172	239
Operating loss	(9,300)	(6,852)
Other expense, net
Interest expense, net	(1,126)	(1,472)
Loss before income tax provision	(10,426)	(8,324)
Income tax provision expense	(63)	(58)
Net loss	(10,489)	(8,382)
Net loss available to common stockholders	$ (12,075)	$ (9,850)
Net loss per common share - basic (in dollars per share)	$ (0.11)	$ (0.09)
Net loss per common share - diluted (in dollars per share)	$ (0.11)	$ (0.09)
Weighted average common shares outstanding - basic (in shares)	111,615,839	109,401,383
Weighted average common shares outstanding - diluted (in shares)	111,615,839	109,401,383

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' (DEFICIT) EQUITY - USD ($) $ in Thousands	Total	Common Stock Issued	Additional Paid-in Capital	Treasury Stock	Accumulated Deficit
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Treasury stock, shares (in shares)				1,773,683
Balance beginning of period (in shares) at Dec. 31, 2020		112,703,926
Balance, beginning of period at Dec. 31, 2020	$ (150)	$ 113	$ 158,610	$ (7,449)	$ (151,424)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Deemed dividends	(462)		(462)
Share-based compensation expense	3,244		3,244
Exercise of stock options	915		(1,364)	$ 2,279
Exercise of stock options (in shares)				(310,813)
Issuance of restricted stock	0		(3,596)	$ 3,596
Issuance of restricted stock (in shares)				742,001
Restricted stock shares canceled/forfeited	0		301	$ (301)
Restricted stock canceled/forfeited (in shares)				35,589
Shares repurchased for tax withholding (in shares)				326,839
Shares repurchased for tax withholding	(3,216)			$ (3,216)
Net loss	(8,382)				(8,382)
Balance end of period (in shares) at Mar. 31, 2021		112,703,926
Balance, end of period at Mar. 31, 2021	$ (8,051)	$ 113	156,733	$ (5,091)	(159,806)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Treasury stock, shares (in shares)				1,083,297
Treasury stock, shares (in shares)	778,710			778,710
Balance beginning of period (in shares) at Dec. 31, 2021	112,703,926	112,703,926
Balance, beginning of period at Dec. 31, 2021	$ 82	$ 113	165,695	$ (4,017)	(161,709)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	3,998		3,998
Exercise of stock options	$ 166		(972)	$ 1,138
Exercise of stock options (in shares)	(124,334)			(124,334)
Issuance of restricted stock	$ 0	$ 1	(3,237)	$ 3,236
Issuance of restricted stock (in shares)		821,252		732,053
Restricted stock shares canceled/forfeited	0		6	$ (6)
Restricted stock canceled/forfeited (in shares)				667
Shares repurchased for tax withholding (in shares)				249,778
Shares repurchased for tax withholding	(1,191)			$ (1,191)
Net loss	$ (10,489)				(10,489)
Balance end of period (in shares) at Mar. 31, 2022	113,525,178	113,525,178
Balance, end of period at Mar. 31, 2022	$ (7,434)	$ 114	$ 165,490	$ (840)	$ (172,198)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Treasury stock, shares (in shares)	172,768			172,768

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash flows from operating activities:
Net loss	$ (10,489)	$ (8,382)
Adjustments to reconcile net loss to net cash flows used in operating activities:
Share-based compensation	3,998	3,244
Depreciation	860	1,161
Amortization of intangible assets	172	239
Amortization of deferred financing costs	112	415
Non-cash lease expenses	295	237
Accretion of asset retirement obligation	22	17
(Gain) loss on fixed asset disposal	(15)	236
Increase (decrease) in cash resulting from changes in:
Accounts receivable	2,679	3
Inventory	(1,781)	(1,221)
Prepaid expenses	11	910
Income taxes	63	54
Other assets	(298)	319
Accounts payable	456	(936)
Accrued compensation	(6,494)	(2,314)
Accrued expenses	550	(484)
Other liabilities	(364)	(177)
Net cash flows used in operating activities	(10,223)	(6,679)
Cash flows from investing activities:
Purchases of equipment	(118)	(1,941)
Patent application costs	(54)	(153)
Principal payments from note receivable	0	15
Principal payments from note receivable	24	0
Net cash flows used in investing activities	(148)	(2,079)
Cash flows from financing activities:
Stock repurchased for tax withholdings on vesting of restricted stock	(1,191)	(3,216)
Proceeds from exercise of stock options	166	915
Principal payments on finance lease	(11)	(7)
Net cash flows used in financing activities	(1,036)	(2,308)
Net change in cash	(11,407)	(11,066)
Cash and cash equivalents, beginning of period	87,083	95,812
Cash and cash equivalents, end of period	$ 75,676	$ 84,746

Nature of Business	3 Months Ended
Nature of Business	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Nature of Business	Nature of Business MiMedx Group, Inc. (together with its subsidiaries, except where the context otherwise requires, “MIMEDX,” or the “Company”) is a transformational placental biologics company, developing and distributing placental tissue allografts with patent-protected, proprietary processes for multiple sectors of healthcare. As a pioneer in placental biologics, the Company is focused on addressing unmet clinical needs in the areas of advanced wound care, surgical recovery applications, and musculoskeletal conditions. The Company derives its products from human placental tissues and process these tissues using its proprietary methods, including the PURION® process. The Company applies Current Good Tissue Practices, Current Good Manufacturing Practices, and terminal sterilization to produce its allografts. MIMEDX provides products primarily in the wound care, burn, and surgical recovery sectors of healthcare. All of its products are regulated by the U.S. Food & Drug Administration (“FDA”). The Company’s business model is focused primarily on the United States of America but the Company is pursuing opportunities for international expansion. Enforcement Discretion In November 2017, the FDA published a series of guidances that established an updated framework for the regulation of cellular and tissue-based products. These guidances clarified the FDA’s views about the criteria that differentiate those products subject to regulation under Section 361 of the Public Health Service Act (“Section 361”) from those considered to be drugs, devices, and/or biological products subject to licensure under Section 351 of the Public Health Service Act and related regulations. The Company identified its micronized and particulate products (collectively, the “Section 351 Products”) as being subject to regulation under Section 351, requiring pre-market approval from the FDA for a specified indication with demonstrated clinical efficacy. The FDA exercised enforcement discretion with respect to Investigational New Drug (“IND”) applications and pre-market approval requirements through May 31, 2021. As of May 31, 2021, the Company stopped marketing its Section 351 Products in the United States and is precluded from marketing such products until a Biologics License Application (“BLA”) is granted. If and when the FDA approves a BLA, the Company expects to be allowed to market its Section 351 Products in the United States, but only for specific indications as permitted by the FDA. Sales of the Company’s Section 351 Products were $0.4 million and $8.1 million for the three months ended March 31, 2022 and 2021, respectively. Sales of Section 351 Products during the three months ended March 31, 2022 were derived from sales outside the United States of America. The Company currently markets EPICORD® and AMNIOCORD® tissue products derived from human umbilical cord as providing a protective environment or as a barrier. If the FDA were to determine that EPICORD and AMNIOCORD do not meet the requirements for regulation solely under Section 361, then pre-market clearance or approval would be required. The loss of the Company’s ability to market and sell its umbilical cord-derived products would have an adverse effect on the Company’s revenue, business, financial condition, and results of operations. Net sales of the Company’s umbilical cord-derived products were $5.6 million and $5.0 million for the three months ended March 31, 2022 and 2021, respectively. The Company’s cord inventory, which would be at risk for write-down in the case of such a determination, was $2.3 million and $1.9 million as of March 31, 2022 and December 31, 2021, respectively.

Significant Accounting Policies	3 Months Ended
Significant Accounting Policies	Mar. 31, 2022
Accounting Policies [Abstract]
Significant Accounting Policies	Significant Accounting Policies Please see Note 2 to the Company’s Consolidated Financial Statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2021 (the “2021 Form 10-K”), filed with the Securities and Exchange Commission (“SEC”) on February 28, 2022 for a description of all significant accounting policies. Basis of Presentation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation of the results of operations for the periods presented have been included. The operating results for the three months ended March 31, 2022 and 2021 are not necessarily indicative of the results that may be expected for the fiscal year. The balance sheet as of December 31, 2021 was derived from the audited consolidated financial statements at that date, but does not include all of the information and footnotes required by GAAP for complete financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with the historical consolidated financial statements of the Company included in the 2021 Form 10-K. Use of Estimates The unaudited condensed consolidated financial statements have been prepared in accordance with GAAP. Conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited condensed consolidated financial statements and the reported unaudited condensed consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment and intangible assets, estimates regarding asset retirement obligations, estimates for contingent liabilities, the measurement of right of use assets and lease liabilities, management’s assessment of the Company’s ability to continue as a going concern, estimates of fair value of share-based payments, estimates of sales returns and allowances, and valuation of deferred tax assets. Principles of Consolidation The unaudited condensed consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation. Recently Adopted Accounting Standards In November 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-10, “Government Assistance (Topic 832)”, which provides disclosure requirements regarding government grants and contributions. The ASU requires disclosure of the nature of transactions and related accounting policies used to account for transactions, the effect, including amounts, of government assistance on individual line items on the financial statements, and significant terms and conditions of the transactions, including commitments and contingencies. This ASU is effective for fiscal years beginning after December 15, 2021. The Company adopted the provisions of this ASU effective January 1, 2022. There was no impact upon adoption. Recently Issued Accounting Standards Not Yet Adopted All ASUs issued and not yet effective for the three months ended March 31, 2022, and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s financial position or results of operations.

Accounts Receivable, Net

3 Months Ended

Mar. 31, 2022

Receivables [Abstract]

Accounts and Nontrade Receivable

Accounts Receivable, Net

Accounts receivable, net, consisted of the following (in thousands):


	March 31, 2022		December 31, 2021
Accounts receivable, gross	$	39,061	$	41,540
Less: allowance for doubtful accounts	(1,387)		(1,187)
Accounts receivable, net	$	37,674	$	40,353

Bad debt expense (reversal), included in selling, general and administrative expense on the condensed consolidated statements of operations, for the three months ended March 31, 2022 and 2021 was as follows (in thousands):


	Three Months Ended March 31,
	2022		2021
Bad debt expense (reversal)	$	223	$	(21)

Inventory

3 Months Ended

Mar. 31, 2022

Inventory Disclosure [Abstract]

Inventory

InventoryInventory consisted of the following (in thousands):


	March 31, 2022		December 31, 2021
Raw materials	$	536	$	364
Work in process	7,229		6,112
Finished goods	5,405		4,913


Inventory	$	13,170	$	11,389

Property and Equipment, Net

3 Months Ended

Mar. 31, 2022

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

Property and equipment, net, consisted of the following (in thousands):


	March 31, 2022		December 31, 2021
Leasehold improvements	$	9,170	$	9,052
Laboratory and clean room equipment	16,255		16,567
Furniture and equipment	14,975		14,975
Construction in progress	683		397
Asset retirement cost	929		863
Finance lease right-of-use asset	189		189
Property and equipment, gross	42,201		42,043
Less: accumulated depreciation	(33,442)		(32,878)
Property and equipment, net	$	8,759	$	9,165

Depreciation expense for the three months ended March 31, 2022 and 2021, respectively, is summarized in the table below (amounts in thousands):


	Three Months Ended March 31,
	2022		2021
Depreciation expense	$	860	$	1,161

Depreciation expense is allocated amongst cost of sales, research and development expense, and selling, general, and administrative expense on the unaudited condensed consolidated statements of operations.

Intangible Assets, Net

3 Months Ended

Mar. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Intangible Assets, Net

Intangible assets, net, are summarized as follows (in thousands):


	March 31, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,657	$	(6,581)	$	3,076	$	9,578	$	(6,408)	$	3,170





Unamortized intangible assets:
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in Process	1,181				1,181		1,205				1,205
Total intangible assets	$	11,846			$	5,265	$	11,791			$	5,383

Amortization expense for the three months ended March 31, 2022 and 2021 is summarized in the table below (amounts in thousands):


	Three Months Ended March 31,
	2022		2021
Amortization expense	$	172	$	239

Expected future amortization of intangible assets as of March 31, 2022, is as follows (in thousands):


Year ending December 31,	Estimated Amortization Expense
2022 (excluding the three months ended March 31, 2022)	$	513
2023	684
2024	684
2025	289
2026	134
Thereafter	772
Total amortized intangible assets	$	3,076

Accrued Expenses

3 Months Ended

Mar. 31, 2022

Payables and Accruals [Abstract]

Accrued Expenses

Accrued expenses consisted of the following (in thousands):


	March 31, 2022		December 31, 2021
Legal and settlement costs	$	3,209	$	2,806

Commissions to sales agents	2,444		2,630
Estimated sales returns	587		788
Accrued clinical trials	713		694
Accrued GPO fees	565		559
Accrued rebates	1,147		1,343
Other	1,147		992
Accrued expenses	$	9,812	$	9,812

Long Term Debt, Net

3 Months Ended

Mar. 31, 2022

Debt Disclosure [Abstract]

Long Term Debt, Net

Hayfin Loan Agreement

On June 30, 2020, the Company entered into a Loan Agreement with, among others, Hayfin Services, LLP (“Hayfin”), an affiliate of Hayfin Capital Management LLP (the “Hayfin Loan Agreement”), which Hayfin funded on July 2, 2020 (the “Closing Date”), providing the Company with a senior secured term loan in an aggregate amount of $50 million (the “Term Loan”). The Term Loan matures on June 30, 2025 (the “Maturity Date”). Interest is payable on the Term Loan for the principal balance outstanding quarterly through the Maturity Date. No principal payments on the Term Loan are due and payable until the Maturity Date.

The Hayfin Loan Agreement also provided the Company an option to draw on an additional delayed draw term loan (the “DD TL,” collectively with the Term Loan, the “Credit Facilities”) in the form of a committed but undrawn facility until June 30, 2021. The Company did not exercise the option.

On February 28, 2022 (the “Amendment Date”), the Company executed an Amendment to the Hayfin Loan Agreement (the “Amendment”). The Amendment was accounted for as a modification. No gain or loss was recognized as a result of the Amendment and there was no change to the carrying amount of the debt on the Amendment Date.

The interest rate applicable to any borrowings under the Hayfin Loan Agreement, as amended, accrues at a rate equal to LIBOR (subject to a floor of 1.5%) plus a margin of 6.75% per annum. If LIBOR is unavailable, the Term Loan will carry interest at the 6.75% margin plus the greatest of the Prime Rate, the Federal Funds Rate plus 0.5% per annum, and 2.5%.

An additional 3.0% margin is applied to the interest rate in the event of a default as defined by the Hayfin Loan Agreement. At issuance and as of March 31, 2022, the Term Loan carried an interest rate of 8.3%.

The Hayfin Loan Agreement, as amended, contains financial covenants requiring the Company, on a consolidated basis, to maintain the following:

•Minimum Consolidated Total Net Sales (as defined in the Hayfin Loan Agreement, as amended) of varying amounts, required to be calculated on a quarterly basis, and

•Minimum Liquidity (as defined in the Hayfin Loan Agreement, as amended) of $20 million, an at-all-times financial covenant tested monthly.

As of March 31, 2022, the Company is in compliance with all financial covenants required under the Hayfin Loan Agreement.

The Hayfin Loan Agreement also includes events of default customary for facilities of this type, and upon the occurrence of such events of default, subject to customary cure rights, the Term Loan may be accelerated or the lenders’ commitments terminated. Mandatory prepayments are also required in the event of a change in control, incurring other indebtedness, certain proceeds from disposal of assets and insured casualty event (as defined in the Hayfin Loan Agreement). Annually, beginning with the fiscal year ended December 31, 2021, the Company is required to prepay the outstanding loans based on a percentage of Excess Cash Flow (as defined in the Hayfin Loan Agreement), if such is generated. No such prepayments have been required as of March 31, 2022.

A breach of a financial covenant in the Hayfin Loan Agreement, if uncured or unable to be cured, would likely result in an event of default that could trigger the lender’s remedies, including acceleration of the entire principal balance of the loan as well as any applicable prepayment premiums.

The Hayfin Loan Agreement, as amended, also specifies that any prepayment of the Term Loan, voluntary or mandatory, will subject the Company to a prepayment premium applicable as of the date of the prepayment as follows:

•On or before July 2, 2023: 2% of the principal balance repaid.

•After July 2, 2023 and on or before July 2, 2024: 1% of the principal balance repaid.

•After July 2, 2024: no premium.

Hayfin maintains a first-priority security interest in substantially all of the Company’s assets.

Original issue discount and deferred financing costs were allocated between the sale of the Series B Preferred Stock (which occurred on the same day as the funding of the Hayfin Loan Agreement as described below in Note 10) and the Hayfin Loan Agreement on the basis of the relative fair values of the transactions. The costs allocated to the Hayfin Loan Agreement were further allocated between the Term Loan and the DD TL on the basis of the maximum potential principal outstanding between the Credit Facilities. The allocation of the deferred financing costs and original issue discount between the Term Loan and the DD TL on July 2, 2020 was as follows (amounts in thousands):


	July 2, 2020
	Term Loan		DD TL		Total

Original issue discount	$	333	$	167	$	500
Deferred financing costs	2,169		1,084		3,253

Deferred financing costs and original issue discount associated with the Term Loan are amortized using the effective interest method through the Maturity Date. The amortization of such amounts is presented as part of interest expense, net on the unaudited condensed consolidated statement of operations. Unamortized deferred financing costs and original issue discount associated with the Term Loan are presented as a reduction to the principal balance on the Term Loan as part of long term debt, net on the unaudited condensed consolidated balance sheets as of March 31, 2022 and December 31, 2021.

Deferred financing costs and original issue discount associated with the DD TL were amortized using the straight line method through the expiration of the DD TL commitment term on June 30, 2021. Amortization of these amounts is presented as part of interest expense, net on the unaudited condensed consolidated statement of operations for the three months ended March 31, 2021. The DD TL was subject to a commitment fee of 1% per annum of the amount undrawn, which was recognized as interest expense.

The balances of the Term Loan as of March 31, 2022 and December 31, 2021 were as follows (amounts in thousands):


	March 31, 2022		December 31, 2021
Outstanding principal	$	50,000	$	50,000
Deferred financing costs	(1,526)		(1,624)
Original issue discount	(235)		(249)
Long term debt, net	$	48,239	$	48,127

Interest expense related to the Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands):


	Three Months Ended March 31,
	2022		2021
Stated interest	$	1,031	$	1,031
Amortization of deferred financing costs	97		89
Accretion of original issue discount	15		13
Interest expense	$	1,143	$	1,133

Interest expense related to the DD TL, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands):


	Three Months Ended March 31,
	2022		2021
Commitment fee	$	—	$	63
Amortization of deferred financing costs	—		271
Accretion of original issue discount	—		41
Interest expense	$	—	$	375

A summary of principal payments due on the Term Loan, by year, from March 31, 2022 through maturity are as follows (amounts in thousands):


Year ending December 31,	Principal
2022 (excluding the three months ended March 31, 2022)	$	—
2023	—
2024	—
2025	50,000
2026	—
Thereafter	—
Total long term debt	$	50,000

As of March 31, 2022, the fair value of the Term Loan was $47.4 million. This valuation was calculated based on a series of Level 2 and Level 3 inputs, including a discount rate based on the credit risk spread of debt instruments of similar risk character in reference to U.S. Treasury instruments with similar maturities, with an incremental risk premium for risk factors specific to the Company. The remaining cash flows associated with the Term Loan were discounted to March 31, 2022 using this discount rate to determine fair value.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

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-Topic 470
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+ Details

Net Loss Per Common Share

3 Months Ended

Mar. 31, 2022

Earnings Per Share [Abstract]

Net Loss Per Common Share

Net loss per common share is calculated using two methods: basic and diluted.

Basic Net Loss Per Common Share

Basic net loss per common share is calculated as net loss available to common stockholders divided by weighted average common shares outstanding. Net loss available to common stockholders is calculated as net loss less (i) dividends accumulated on the Company’s Series B Convertible Preferred Stock during the period, and (ii) periodic accretion of the increasing-rate dividend feature.

The following table provides a reconciliation of net loss to net loss available to common stockholders and calculation of basic net loss per common share for each of the three months ended March 31, 2022 and 2021 (amounts in thousands, except share and per share amounts):


	Three Months Ended March 31,
	2022		2021
Net loss	$	(10,489)	$	(8,382)
Adjustments to reconcile to net loss available to common stockholders
Accumulated dividend on Series B Preferred Stock	1,586		1,006
Accretion of increasing-rate dividend feature	—		462
Total adjustments	1,586		1,468
Net loss available to common stockholders	$	(12,075)	$	(9,850)
Weighted average common shares outstanding	111,615,839		109,401,383
Basic net loss per common share	$	(0.11)	$	(0.09)

Diluted Net Loss Per Common Share

Diluted net loss per common share is calculated as net loss available to common stockholders, adjusted for dividends on convertible preferred stock (to the extent such conversions would be dilutive), divided by weighted average common shares outstanding plus potential common shares. The calculation of potential common shares considers incremental shares resulting from certain transactions, including the exercise of stock options and the issuance of restricted stock using the treasury stock method, as well as the hypothetical conversion of the Company’s Series B Convertible Preferred Stock using the if-converted method. The treasury stock method assumes that proceeds from the transaction are used to purchase common stock at the average market price throughout the period. The if-converted method adds back periodic accrued or deemed dividends on the Company’s Series B Convertible Preferred Stock, and assumes conversion as of the beginning of the period.

Each individual transaction is assessed for its dilutive effect on net loss per common share. To the extent that the transaction is antidilutive or does not reduce net loss per common share, the effect is excluded from the calculation.

The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per share amounts):


	Three Months Ended March 31,
	2022		2021
Net loss available to common stockholders	$	(12,075)	$	(9,850)
Adjustments:
Dividends on Series B Convertible Preferred Stock	1,586		1,468
Less: antidilutive adjustments	(1,586)		(1,468)
Total adjustments	—		—
Numerator	$	(12,075)	$	(9,850)
Weighted average shares outstanding	111,615,839		109,401,383
Adjustments
Potential common shares	29,459,846		30,470,089
Less: antidilutive potential common shares (a)	(29,459,846)		(30,470,089)
Total adjustments	—		—
Weighted average shares outstanding adjusted for potential common shares	111,615,839		109,401,383
Diluted net loss per common share	$	(0.11)	$	(0.09)

(a) Weighted average common shares outstanding for the calculation of diluted net loss per common share does not include the following adjustments for potential common shares below because their effects were determined to be antidilutive for the periods presented.


	Three Months Ended March 31,
	2022	2021
Series B Convertible Preferred Stock	27,850,916	26,497,570
Restricted stock awards	597,805	1,629,273
Restricted stock unit awards	822,642	1,349,898
Outstanding stock options	188,483	964,640
Performance stock unit awards	—	28,708
Potential common shares	29,459,846	30,470,089

Equity

3 Months Ended

Mar. 31, 2022

Equity [Abstract]

Equity

Series B Convertible Preferred Stock

The Series B Convertible Preferred Stock of the Company (the “Series B Preferred Stock”) paid a 4.0% cumulative dividend per annum prior to the quarterly dividend payment ending on June 30, 2021, and pays a 6.0% cumulative dividend per annum thereafter. Dividends, if declared, are paid at the end of each quarter based on dividend amounts that accumulate beginning on the last payment date through the day prior to the end of each quarter. In lieu of paying a dividend, the Company may elect to accrue the dividend owed to shareholders. Accrued dividend balances accumulate dividends at the prevailing dividend rate for each dividend period for which they are outstanding.

Each share of Series B Preferred Stock is convertible into the Company’s common stock at any time at the option of the holder. Shares are converted based on the liquidation preference of $1,000 per share (the “Liquidation Preference”) plus any accrued or accumulated dividends through the date of the conversion at a conversion price of $3.85 per common share. The Series B Preferred Stock, including any accumulated and unpaid dividends, automatically converts into common stock at any time after July 2, 2023, provided that the common stock has traded at $7.70 per share or more for (i) 20 out of the preceding 30 consecutive trading days and (ii) on such date of conversion.

The holders of the Series B Preferred Stock, voting as a class, are entitled to appoint two members to the board of directors. The holders of the Series B Preferred Stock are entitled to vote on all matters to be voted on by the Company’s shareholders on an

as-converted basis as a single class with the common stock assuming a conversion price of $5.25 per share; provided that the votes represented by the Series B Preferred Stock cannot exceed 19.9% of the total voting stock of the Company.

Holders of the Series B Preferred Stock are also entitled to the Liquidation Preference plus all accumulated and unpaid dividends in the event of a liquidation, dissolution, or winding-up of the Company.

If the Company undergoes a change of control (as defined), the Company will have the option to repurchase some or all of the then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the Liquidation Preference plus any accumulated and unpaid dividends, subject to the rights of the holders of the Series B Preferred Stock in connection with such change in control. If the Company does not exercise such repurchase right, holders of the Series B Preferred Stock will have the option to (1) require the Company to repurchase any or all of their then-outstanding shares of Series B Preferred Stock for cash in an amount equal to the Liquidation Preference plus accumulated and unpaid dividends or (2) convert the Series B Preferred Stock into common stock and receive their pro rata consideration thereunder. Since the contingent redemption of the Series B Preferred Stock by the holders in the event of change in control is outside the Company’s control, the Series B Preferred Stock is classified as temporary equity.

The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended March 31, 2022 (in thousands, except share amounts):


	Series B Preferred Stock
	Shares	Amount
Balance at December 31, 2021	100,000	$	92,494
Activity	—	—
Balance at March 31, 2022	100,000	$	92,494

The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended March 31, 2021 (in thousands, except share amounts):


	Series B Preferred Stock
	Shares	Amount
Balance at December 31, 2020	100,000	$	91,568
Deemed dividends	—	462
Balance at March 31, 2021	100,000	$	92,030

The Company has not declared or paid any dividends on the Series B Preferred Stock since issuance. Dividends accumulated but not paid as of March 31, 2022 was $8.8 million. As this amount has not been declared, the Company has not recorded this amount on its unaudited condensed consolidated balance sheet as of March 31, 2022.

Based on accumulated dividends as of March 31, 2022, the Series B Preferred Stock was convertible into an aggregate of 28,262,957 shares of the Company’s common stock.

Restricted Stock Awards

The Company has issued several classes of restricted stock awards to employees: restricted stock awards (“RSAs”), restricted stock unit awards (“RSUs”), and performance stock unit awards (“PSUs”). The following is summary information for restricted stock awards for the three months ended March 31, 2022.

As of March 31, 2022, there was $30.8 million of unrecognized share-based compensation expense related to restricted stock awards. This expense is expected to be recognized over a weighted-average period of 2.24 years, which approximates the remaining vesting period of these grants.

The below table summarizes activity of unvested restricted stock awards by award type from January 1, 2022 through March 31, 2022. Unvested RSA awards noted below are included in issued and outstanding common stock as of March 31, 2022, while unvested RSU awards are not included in issued or outstanding common stock as of March 31, 2022.


	RSA			RSU
	Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value
Unvested at January 1, 2022	877,197	$	4.26	4,228,919	$	8.64
Granted	—	—		2,183,670	5.21
Vested	(16,001)	3.14		(1,553,305)	8.18
Forfeited	(667)	5.12		(46,155)	10.07
Unvested at March 31, 2022	860,529	$	4.28	4,813,129	$	7.22

Stock Options

A summary of stock option activity for the three months ended March 31, 2022 is presented below:


	Number of Shares	Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (in years)	Aggregate Intrinsic Value
Outstanding at January 1, 2022	1,444,845	$	5.18
Granted	—	—
Exercised	(124,334)	1.33
Unvested options forfeited	—	—
Vested options expired	(5,000)	7.24
Outstanding at March 31, 2022	1,315,511	5.53		1.39	696,582
Exercisable at March 31, 2022	1,315,511	$	5.53	1.39	$	696,582

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

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+ Details

Income taxes	3 Months Ended
Income taxes	Mar. 31, 2022
Income Tax Disclosure [Abstract]
Income taxes	Income TaxesThe effective tax rates for the Company were (0.6)% and (0.7)% for the three months ended March 31, 2022 and March 31, 2021, respectively. There were no material discrete items affecting the effective tax rate in either period. Net operating losses incurred during both periods were offset by a valuation allowance.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

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+ Details

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities

3 Months Ended

Mar. 31, 2022

Supplemental Cash Flow Elements [Abstract]

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities

Selected cash payments, receipts, and non-cash activities are as follows (in thousands):


	Three Months Ended March 31,
	2022		2021
Cash paid for interest	$	1,034	$	1,094
Income taxes paid	—		4
Non-cash activities:
Right of use assets arising from operating lease liabilities	(37)		—
Right of use assets arising from finance lease liabilities	—		189
Note receivable for sale of property and equipment	—		75
Purchases of equipment in accounts payable	287		159
Fair value of non-cash consideration received for option exercise	—		380
Deemed dividends on Series B Preferred Stock	—		462

Contractual Commitments and Contingencies	3 Months Ended
Contractual Commitments and Contingencies	Mar. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Contractual Commitments and Contingencies	Commitments and Contingencies Litigation and Regulatory Matters In the ordinary course of business, the Company and its subsidiaries are parties to numerous civil claims and lawsuits and subject to regulatory examinations, investigations, and requests for information. Some of these matters involve claims for substantial amounts. The Company’s experience has shown that the damages alleged by plaintiffs or claimants are in many cases overstated, based on unsubstantiated legal theories, unsupported by facts, and/or bear no relation to the ultimate award that a court might grant. Additionally, the outcome of litigation and regulatory matters and the timing of ultimate resolution are inherently difficult to predict. These factors make it difficult for the Company to provide a meaningful estimate of the range of reasonably possible outcomes of claims in the aggregate or by individual claim. However, on a case-by-case basis, reserves are established for those legal claims in which it is probable that a loss will be incurred and the amount of such loss can be reasonably estimated. The Company's unaudited condensed consolidated balance sheet as of March 31, 2022 reflect the Company's current best estimate of probable losses associated with these matters, including costs to comply with various settlement agreements, where applicable. The actual costs of resolving these claims, as well as the cost to resolve claims that are either not probable or not estimable at this time, may be substantially higher or lower than the amounts reserved. For more information regarding the Company’s legal proceedings, refer to Note 14, “Commitments and Contingencies” in the 2021 Form 10-K. As of March 31, 2022, the Company has accrued $0.3 million related to legal proceedings. The actual costs to resolve these matters may be in excess of the amounts reserved. The Company paid $0.4 million toward the resolution of legal matters involving the Company during the three months ended March 31, 2022. In addition, insurance providers have paid $0.6 million on the Company’s behalf to settle legal matters. In addition, the Company recovered amounts from certain former officers and directors of the Company relating to legal fees previously advanced on their behalf. These funds were recognized as a reduction to investigation, restatement, and related expense on the condensed consolidated statement of operations for the three months ended March 31, 2022. The following is a description of certain litigation and regulatory matters: Securities Class Action On January 16, 2019, the United States District Court for the Northern District of Georgia entered an order consolidating two purported securities class actions (MacPhee v. MiMedx Group, Inc., et al. filed February 23, 2018 and Kline v. MiMedx Group, Inc., et al. filed February 26, 2018). The order also appointed Carpenters Pension Fund of Illinois (“CPFI”) as lead plaintiff. On May 1, 2019, CPFI filed a consolidated amended complaint, naming as defendants the Company, Michael J. Senken, Parker H. “Pete” Petit, William C. Taylor, Christopher M. Cashman and Cherry Bekaert & Holland LLP. The amended complaint (the “Securities Class Action Complaint”) alleged violations of Section 10(b) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), Rule 10b-5 promulgated thereunder, and Section 20(a) of the Exchange Act. It asserted a class period of March 7, 2013 through June 29, 2018. Following the filing of motions to dismiss by the various defendants, CPFI was granted leave to file an amended complaint. CPFI filed its amended complaint against the Company, Michael J. Senken, Parker H. Petit, William C. Taylor, and Cherry Bekaert & Holland (Christopher Cashman was dropped as a defendant) on March 30, 2020. The defendants filed motions to dismiss on May 29, 2020. On March 25, 2021, the Court granted defendants’ respective motions to dismiss, finding that CPFI lacked standing to bring the underlying claims and also could not establish loss causation because it sold all of its shares in MIMEDX prior to any corrective disclosures, and dismissed the case. On April 22, 2021, CPFI filed a motion for reconsideration of the dismissal and for leave to amend to add a new plaintiff to attempt to cure the standing and loss causation issues. On January 28, 2022, the Court denied CPFI’s motion to reconsider and motion to substitute class representative. On February 25, 2022, CPFI filed a Notice of Appeal in the 11th Circuit Court of Appeals. Former Employee Litigation and Related Matters On January 12, 2021, the Company filed suit in the Circuit Court of the Eleventh Judicial District in and for Miami-Dade County, Florida (MiMedx Group, Inc. v. Petit, et. al.) against its former CEO, Parker H. “Pete” Petit, and its former COO, William C. Taylor, seeking a determination of its rights and obligations under indemnification agreements with Petit and Taylor following a federal jury’s guilty verdict against Petit for securities fraud and Taylor for conspiracy to commit securities fraud. The Company is seeking a declaratory judgment that it is not obligated to indemnify or advance expenses to Petit and Taylor in connection with certain cases to which Petit and Taylor are parties and also seeking to recoup amounts previously paid on behalf of Petit and Taylor in connection with such cases. On April 22, 2021, Petit and Taylor filed an answer and asserted counterclaims against the Company alleging breach of their indemnification agreements, breach of the covenant of good faith and fair dealing with respect to their indemnification agreements, and seeking a declaration that the Company remains obligated to indemnify and advance fees in connection with certain cases. Petit and Taylor simultaneously also filed a motion seeking to compel the Company to advance and reinstate its payments of Petit and Taylor’s legal expenses. The Company opposed Petit and Taylor’s motion and a hearing was set for June 23, 2021. At the joint request of the parties, the hearing was cancelled to allow the parties to attend a mediation to attempt a resolution of this matter; such mediation was held on August 11, 2021. Since the mediation, the Company and Mr. Taylor reached an agreement to settle the matter between them. Negotiations with Mr. Petit are ongoing. Other Matters Under the Florida Business Corporation Act and agreements with its current and former officers and directors, the Company is obligated to indemnify its current and former officers and directors who are made party to a proceeding, including a proceeding brought by or in the right of the corporation, with certain exceptions, and to advance expenses to defend such matters. The Company has already borne substantial costs to satisfy these indemnification and expense advance obligations and may continue to do so in the future. In addition to the matters described above, the Company is a party to a variety of other legal matters that arise in the ordinary course of the Company’s business, none of which is deemed to be individually material at this time. Due to the inherent uncertainty of litigation, there can be no assurance that the resolution of any particular claim or proceeding would not have a material adverse effect on the Company’s business, results of operations, financial position or liquidity.

Revenue

3 Months Ended

Mar. 31, 2022

Segment Reporting [Abstract]

Revenue

Disaggregation of Revenue by Product

MIMEDX has two primary classes of products: (1) Advanced Wound Care, or Section 361, products, consisting of its tissue and cord sheet allograft products, and (2) Section 351 Products, consisting of the Company’s micronized and particulate products. Advanced Wound Care is further disaggregated between the Company’s Tissue/Other and Cord products.

Below is a summary of net sales by each class of product (in thousands):


	Three Months Ended March 31,
	2022		2021
Advanced Wound Care
Tissue/Other	$	52,852	$	46,569
Cord	5,597		4,960
Total Advanced Wound Care	58,449		51,529
Section 351	377		8,140
Other(1)	68		298
Net sales	$	58,894	$	59,967

(1) “Other” represents revenue transactions in the indicated period relating to performance obligations settled prior to October 1, 2019, the date at which the Company changed its pattern of revenue recognition. For all practical purposes, the Company is not able to allocate these revenue transactions to different product groups.

Disaggregation of Revenue by Customer

MIMEDX has two primary distribution channels: (1) direct to customers (healthcare professionals and/or facilities) (“Direct Customers”), and (2) sales through distributors (“Distributors”).

Below is a summary of net sales by each customer type (in thousands):


	Three Months Ended March 31,
	2022		2021
Direct Customers	$	57,473	$	57,555
Distributors	1,421		2,412
Net sales	$	58,894	$	59,967

The Company did not have significant foreign operations or a single external customer from which 10% or more of revenues were derived during the three months ended March 31, 2022 or 2021.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130554-203045

+ Details

Significant Accounting Policies (Policies)	3 Months Ended
Significant Accounting Policies (Policies)	Mar. 31, 2022
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation of the results of operations for the periods presented have been included. The operating results for the three months ended March 31, 2022 and 2021 are not necessarily indicative of the results that may be expected for the fiscal year. The balance sheet as of December 31, 2021 was derived from the audited consolidated financial statements at that date, but does not include all of the information and footnotes required by GAAP for complete financial statements. These unaudited condensed consolidated financial statements should be read in conjunction with the historical consolidated financial statements of the Company included in the 2021 Form 10-K.
Use of Estimates	Use of Estimates The unaudited condensed consolidated financial statements have been prepared in accordance with GAAP. Conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the unaudited condensed consolidated financial statements and the reported unaudited condensed consolidated statements of operations during the reporting period. Actual results could differ from those estimates. Significant estimates include estimated useful lives and potential impairment of property and equipment and intangible assets, estimates regarding asset retirement obligations, estimates for contingent liabilities, the measurement of right of use assets and lease liabilities, management’s assessment of the Company’s ability to continue as a going concern, estimates of fair value of share-based payments, estimates of sales returns and allowances, and valuation of deferred tax assets.
Principles of Consolidation	Principles of Consolidation The unaudited condensed consolidated financial statements include the accounts of MiMedx Group, Inc. and its wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated upon consolidation.
Recently Issued and Adopted Accounting Standards	Recently Adopted Accounting Standards In November 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-10, “Government Assistance (Topic 832)”, which provides disclosure requirements regarding government grants and contributions. The ASU requires disclosure of the nature of transactions and related accounting policies used to account for transactions, the effect, including amounts, of government assistance on individual line items on the financial statements, and significant terms and conditions of the transactions, including commitments and contingencies. This ASU is effective for fiscal years beginning after December 15, 2021. The Company adopted the provisions of this ASU effective January 1, 2022. There was no impact upon adoption. Recently Issued Accounting Standards Not Yet Adopted All ASUs issued and not yet effective for the three months ended March 31, 2022, and through the date of this report, were assessed and determined to be either not applicable or are expected to have minimal impact on the Company’s financial position or results of operations.

Accounts Receivable, Net (Tables)

3 Months Ended

Mar. 31, 2022

Receivables [Abstract]

Schedule of Accounts, Notes, Loans and Financing Receivable

Accounts receivable, net, consisted of the following (in thousands):


	March 31, 2022		December 31, 2021
Accounts receivable, gross	$	39,061	$	41,540
Less: allowance for doubtful accounts	(1,387)		(1,187)
Accounts receivable, net	$	37,674	$	40,353

Accounts Receivable, Allowance for Credit Loss


	Three Months Ended March 31,
	2022		2021
Bad debt expense (reversal)	$	223	$	(21)

Inventory (Tables)

3 Months Ended

Mar. 31, 2022

Inventory Disclosure [Abstract]

Inventory

Inventory consisted of the following (in thousands):


	March 31, 2022		December 31, 2021
Raw materials	$	536	$	364
Work in process	7,229		6,112
Finished goods	5,405		4,913


Inventory	$	13,170	$	11,389

Property and Equipment, Net (Tables)

3 Months Ended

Mar. 31, 2022

Property, Plant and Equipment [Abstract]

Summary of Property and Equipment

Property and equipment, net, consisted of the following (in thousands):


	March 31, 2022		December 31, 2021
Leasehold improvements	$	9,170	$	9,052
Laboratory and clean room equipment	16,255		16,567
Furniture and equipment	14,975		14,975
Construction in progress	683		397
Asset retirement cost	929		863
Finance lease right-of-use asset	189		189
Property and equipment, gross	42,201		42,043
Less: accumulated depreciation	(33,442)		(32,878)
Property and equipment, net	$	8,759	$	9,165

Schedule of Depreciation Expense

Depreciation expense for the three months ended March 31, 2022 and 2021, respectively, is summarized in the table below (amounts in thousands):


	Three Months Ended March 31,
	2022		2021
Depreciation expense	$	860	$	1,161

Intangible Assets, Net (Tables)

3 Months Ended

Mar. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Intangible Assets Activity Summary - Indefinite-lived

Intangible assets, net, are summarized as follows (in thousands):


	March 31, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,657	$	(6,581)	$	3,076	$	9,578	$	(6,408)	$	3,170





Unamortized intangible assets:
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in Process	1,181				1,181		1,205				1,205
Total intangible assets	$	11,846			$	5,265	$	11,791			$	5,383

Intangible Assets Activity Summary - Finite-lived

Intangible assets, net, are summarized as follows (in thousands):


	March 31, 2022						December 31, 2021
	Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization		Net Carrying Amount
Amortized intangible assets
Patents and know-how	$	9,657	$	(6,581)	$	3,076	$	9,578	$	(6,408)	$	3,170





Unamortized intangible assets:
Tradenames and trademarks	$	1,008			$	1,008	$	1,008			$	1,008
Patents in Process	1,181				1,181		1,205				1,205
Total intangible assets	$	11,846			$	5,265	$	11,791			$	5,383

Amortization expense for the three months ended March 31, 2022 and 2021 is summarized in the table below (amounts in thousands):


	Three Months Ended March 31,
	2022		2021
Amortization expense	$	172	$	239

Estimated Future Amortization Expense for Intangible Assets

Expected future amortization of intangible assets as of March 31, 2022, is as follows (in thousands):


Year ending December 31,	Estimated Amortization Expense
2022 (excluding the three months ended March 31, 2022)	$	513
2023	684
2024	684
2025	289
2026	134
Thereafter	772
Total amortized intangible assets	$	3,076

Accrued Expenses (Tables)

3 Months Ended

Mar. 31, 2022

Payables and Accruals [Abstract]

Schedule of Accrued Liabilities

Accrued expenses consisted of the following (in thousands):


	March 31, 2022		December 31, 2021
Legal and settlement costs	$	3,209	$	2,806

Commissions to sales agents	2,444		2,630
Estimated sales returns	587		788
Accrued clinical trials	713		694
Accrued GPO fees	565		559
Accrued rebates	1,147		1,343
Other	1,147		992
Accrued expenses	$	9,812	$	9,812

Long Term Debt, Net (Tables)

3 Months Ended

Mar. 31, 2022

Debt Disclosure [Abstract]

Schedule of Debt Issuance Costs

The allocation of the deferred financing costs and original issue discount between the Term Loan and the DD TL on July 2, 2020 was as follows (amounts in thousands):


	July 2, 2020
	Term Loan		DD TL		Total

Original issue discount	$	333	$	167	$	500
Deferred financing costs	2,169		1,084		3,253

Schedule of Debt

The balances of the Term Loan as of March 31, 2022 and December 31, 2021 were as follows (amounts in thousands):


	March 31, 2022		December 31, 2021
Outstanding principal	$	50,000	$	50,000
Deferred financing costs	(1,526)		(1,624)
Original issue discount	(235)		(249)
Long term debt, net	$	48,239	$	48,127

Schedule of Interest Expense

Interest expense related to the Term Loan, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands):


	Three Months Ended March 31,
	2022		2021
Stated interest	$	1,031	$	1,031
Amortization of deferred financing costs	97		89
Accretion of original issue discount	15		13
Interest expense	$	1,143	$	1,133

Interest expense related to the DD TL, included in interest expense, net in the unaudited condensed consolidated statements of operations, was as follows (amounts in thousands):


	Three Months Ended March 31,
	2022		2021
Commitment fee	$	—	$	63
Amortization of deferred financing costs	—		271
Accretion of original issue discount	—		41
Interest expense	$	—	$	375

Future Principal Payments for the Term Loan

A summary of principal payments due on the Term Loan, by year, from March 31, 2022 through maturity are as follows (amounts in thousands):


Year ending December 31,	Principal
2022 (excluding the three months ended March 31, 2022)	$	—
2023	—
2024	—
2025	50,000
2026	—
Thereafter	—
Total long term debt	$	50,000

Net Loss Per Common Share (Tables)

3 Months Ended

Mar. 31, 2022

Earnings Per Share [Abstract]

Schedule of Earnings Per Share, Basic


	Three Months Ended March 31,
	2022		2021
Net loss	$	(10,489)	$	(8,382)
Adjustments to reconcile to net loss available to common stockholders
Accumulated dividend on Series B Preferred Stock	1,586		1,006
Accretion of increasing-rate dividend feature	—		462
Total adjustments	1,586		1,468
Net loss available to common stockholders	$	(12,075)	$	(9,850)
Weighted average common shares outstanding	111,615,839		109,401,383
Basic net loss per common share	$	(0.11)	$	(0.09)

Schedule of Earnings Per Share, Diluted

The following table sets forth the computation of diluted net loss per common share (in thousands, except share and per share amounts):


	Three Months Ended March 31,
	2022		2021
Net loss available to common stockholders	$	(12,075)	$	(9,850)
Adjustments:
Dividends on Series B Convertible Preferred Stock	1,586		1,468
Less: antidilutive adjustments	(1,586)		(1,468)
Total adjustments	—		—
Numerator	$	(12,075)	$	(9,850)
Weighted average shares outstanding	111,615,839		109,401,383
Adjustments
Potential common shares	29,459,846		30,470,089
Less: antidilutive potential common shares (a)	(29,459,846)		(30,470,089)
Total adjustments	—		—
Weighted average shares outstanding adjusted for potential common shares	111,615,839		109,401,383
Diluted net loss per common share	$	(0.11)	$	(0.09)

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share


	Three Months Ended March 31,
	2022	2021
Series B Convertible Preferred Stock	27,850,916	26,497,570
Restricted stock awards	597,805	1,629,273
Restricted stock unit awards	822,642	1,349,898
Outstanding stock options	188,483	964,640
Performance stock unit awards	—	28,708
Potential common shares	29,459,846	30,470,089

Equity Equity (Tables)

3 Months Ended

Mar. 31, 2022

Equity [Abstract]

Schedule of Series B Preferred Stock

The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended March 31, 2022 (in thousands, except share amounts):


	Series B Preferred Stock
	Shares	Amount
Balance at December 31, 2021	100,000	$	92,494
Activity	—	—
Balance at March 31, 2022	100,000	$	92,494

The below table illustrates changes in the Company’s balance of Series B Preferred Stock for the three months ended March 31, 2021 (in thousands, except share amounts):


	Series B Preferred Stock
	Shares	Amount
Balance at December 31, 2020	100,000	$	91,568
Deemed dividends	—	462
Balance at March 31, 2021	100,000	$	92,030

Summary of Restricted Stock Awards by Award Type


	RSA			RSU
	Number of Shares	Weighted-Average Grant Date Fair Value		Number of Shares	Weighted-Average Grant Date Fair Value
Unvested at January 1, 2022	877,197	$	4.26	4,228,919	$	8.64
Granted	—	—		2,183,670	5.21
Vested	(16,001)	3.14		(1,553,305)	8.18
Forfeited	(667)	5.12		(46,155)	10.07
Unvested at March 31, 2022	860,529	$	4.28	4,813,129	$	7.22

Summary of Stock Options Activity

A summary of stock option activity for the three months ended March 31, 2022 is presented below:


	Number of Shares	Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (in years)	Aggregate Intrinsic Value
Outstanding at January 1, 2022	1,444,845	$	5.18
Granted	—	—
Exercised	(124,334)	1.33
Unvested options forfeited	—	—
Vested options expired	(5,000)	7.24
Outstanding at March 31, 2022	1,315,511	5.53		1.39	696,582
Exercisable at March 31, 2022	1,315,511	$	5.53	1.39	$	696,582

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities (Tables)

3 Months Ended

Mar. 31, 2022

Supplemental Cash Flow Elements [Abstract]

Supplemental Disclosure of Cash Flow and Non-cash Investing and Financing Activities

Selected cash payments, receipts, and non-cash activities are as follows (in thousands):


	Three Months Ended March 31,
	2022		2021
Cash paid for interest	$	1,034	$	1,094
Income taxes paid	—		4
Non-cash activities:
Right of use assets arising from operating lease liabilities	(37)		—
Right of use assets arising from finance lease liabilities	—		189
Note receivable for sale of property and equipment	—		75
Purchases of equipment in accounts payable	287		159
Fair value of non-cash consideration received for option exercise	—		380
Deemed dividends on Series B Preferred Stock	—		462

Revenue (Tables)

3 Months Ended

Mar. 31, 2022

Segment Reporting [Abstract]

Disaggregation of Revenue

Below is a summary of net sales by each class of product (in thousands):


	Three Months Ended March 31,
	2022		2021
Advanced Wound Care
Tissue/Other	$	52,852	$	46,569
Cord	5,597		4,960
Total Advanced Wound Care	58,449		51,529
Section 351	377		8,140
Other(1)	68		298
Net sales	$	58,894	$	59,967

Below is a summary of net sales by each customer type (in thousands):


	Three Months Ended March 31,
	2022		2021
Direct Customers	$	57,473	$	57,555
Distributors	1,421		2,412
Net sales	$	58,894	$	59,967

Nature of Business (Details) - USD ($) $ in Thousands	3 Months Ended
Nature of Business (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Unusual or Infrequent Item, or Both [Line Items]
Net sales	$ 58,894	$ 59,967
Inventory	13,170		$ 11,389
Section 351
Unusual or Infrequent Item, or Both [Line Items]
Net sales	377	8,140
Cord
Unusual or Infrequent Item, or Both [Line Items]
Net sales	5,597	$ 4,960
Inventory	$ 2,300		$ 1,900

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Accounts Receivable, Net - Accounts Receivable (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Receivables [Abstract]
Accounts receivable, gross	$ 39,061	$ 41,540
Less: allowance for doubtful accounts	(1,387)	(1,187)
Accounts receivable, net	$ 37,674	$ 40,353

Accounts Receivable, Net - Bad Debt Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Receivables [Abstract]
Bad debt expense (reversal)	$ 223	$ (21)

Inventory (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Inventory Disclosure [Abstract]
Raw materials	$ 536	$ 364
Work in process	7,229	6,112
Finished goods	5,405	4,913
Inventory	$ 13,170	$ 11,389

Property and Equipment, Net - Summary of Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Finance lease right-of-use asset	$ 189	$ 189
Property and equipment, gross	42,201	42,043
Less: accumulated depreciation	(33,442)	(32,878)
Property and equipment, net	8,759	9,165
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	9,170	9,052
Laboratory and clean room equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	16,255	16,567
Furniture and equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	14,975	14,975
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	683	397
Asset retirement cost
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 929	$ 863

Property and Equipment, Net - Depreciation Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 860	$ 1,161

Intangible Assets, Net - Activity Summary (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]
Net Carrying Amount	$ 3,076
Intangible assets, net	5,265	$ 5,383
Indefinite-lived Intangible Assets [Line Items]
Intangible assets, gross carrying amount	11,846	11,791
Intangible assets, net carrying amount	5,265	5,383
Tradenames and trademarks
Finite-Lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,008	1,008
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,008	1,008
Patents in Process
Finite-Lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,181	1,205
Indefinite-lived Intangible Assets [Line Items]
Gross carrying value, indefinite lived	1,181	1,205
Patents and know-how
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	9,657	9,578
Accumulated Amortization	(6,581)	(6,408)
Net Carrying Amount	$ 3,076	$ 3,170

Intangible Assets, Net - Amortization Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 172	$ 239

Intangible Assets, Net - Estimated Future Amortization Expense for Intangible Assets (Details) $ in Thousands	Mar. 31, 2022 USD ($)
Estimated future amortization expense [Abstract]
2022 (excluding the three months ended March 31, 2022)	$ 513
2023	684
2024	684
2025	289
2026	134
Thereafter	772
Net Carrying Amount	$ 3,076

Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Legal and settlement costs	$ 3,209	$ 2,806
Commissions to sales agents	2,444	2,630
Estimated sales returns	587	788
Accrued clinical trials	713	694
Accrued GPO fees	565	559
Accrued rebates	1,147	1,343
Other	1,147	992
Accrued expenses	$ 9,812	$ 9,812

Long Term Debt, Net - Term Loan (Details) - Term loan - USD ($)			3 Months Ended
	Feb. 28, 2022	Jul. 02, 2020	Mar. 31, 2022	Dec. 31, 2021
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Principal issued		$ 50,000,000
Original issue discount		333,000	$ 235,000	$ 249,000
Deferred financing costs		$ 2,169,000
Hayfin Loan Agreement Term Loan \| London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument, interest rate, floor (percent)		1.50%
Debt instrument, basis spread on variable rate		6.75%
Default interest rate (percent)		3.00%
Interest rate at issuance (percent)			8.30%
Credit Facilities
Debt Instrument [Line Items]
Debt covenant, minimum liquidity	$ 20,000,000
Original issue discount		$ 500,000
Deferred financing costs		$ 3,253,000
Credit Facilities \| Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Debt instrument, prepayment make-whole premium as percent of prepaid principal (percent)		2.00%
Credit Facilities \| Debt Instrument, Redemption, Period Two
Debt Instrument [Line Items]
Debt instrument, prepayment make-whole premium as percent of prepaid principal (percent)		1.00%
Credit Facilities \| Debt Instrument, Redemption, Period Three
Debt Instrument [Line Items]
Debt instrument, prepayment make-whole premium as percent of prepaid principal (percent)		0.00%
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Additional commitment fee (percent)		1.00%
Original issue discount		$ 167,000
Deferred financing costs		$ 1,084,000
BT Term Loan
Debt Instrument [Line Items]
Fair value of the Term Loan			$ 47,400,000
Minimum \| Hayfin Loan Agreement Term Loan \| Prime Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate		0.50%
Maximum \| Hayfin Loan Agreement Term Loan \| Fed Funds Effective Rate Overnight Index Swap Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate		2.50%

Long Term Debt, Net - Term Loan Debt Issuance Costs (Details) - Term loan - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021	Jul. 02, 2020
Credit Facilities
Debt Instrument [Line Items]
Deferred financing costs			$ 3,253
Debt Instrument, Unamortized Discount			500
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Deferred financing costs			2,169
Debt Instrument, Unamortized Discount	$ 235	$ 249	333
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Deferred financing costs			1,084
Debt Instrument, Unamortized Discount			$ 167

Long Term Debt, Net - Term Loan Balances (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021	Jul. 02, 2020
Debt Instrument [Line Items]
Outstanding principal	$ 50,000
Term loan \| Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Outstanding principal	50,000	$ 50,000
Deferred financing costs	(1,526)	(1,624)
Original issue discount	(235)	(249)	$ (333)
Long term debt, net	$ 48,239	$ 48,127

- Definition

Amount, after unamortized (discount) premium and debt issuance costs, of long-term debt. Includes, but not limited to, notes payable, bonds payable, debentures, mortgage loans and commercial paper. Excludes capital lease obligations.

+ References + Details

Long Term Debt, Net - Term Loan Interest Expense (Details) - Term loan - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Hayfin Loan Agreement Term Loan
Debt Instrument [Line Items]
Stated interest	$ 1,031	$ 1,031
Amortization of deferred financing costs	97	89
Accretion of original issue discount	15	13
Interest expense	1,143	1,133
Hayfin Loan Agreement Delayed Draw Term Loan
Debt Instrument [Line Items]
Commitment fee	0	63
Amortization of deferred financing costs	0	271
Accretion of original issue discount	0	41
Interest expense	$ 0	$ 375

Long Term Debt, Net - Term Loan Maturity (Details) $ in Thousands	Mar. 31, 2022 USD ($)
Debt Disclosure [Abstract]
2022 (excluding the three months ended March 31, 2022)	$ 0
2023	0
2024	0
2025	50,000
2026	0
Thereafter	0
Long term debt, net	$ 50,000

Net Loss Per Common Share - Basic and Diluted Net Loss Per Common Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Computation of basic and diluted net loss per share [Abstract]
Net loss	$ (10,489)	$ (8,382)
Adjustments:
Dividends on Series B Convertible Preferred Stock	1,586	1,006
Less: antidilutive adjustments	(1,586)	(1,468)
Total adjustments	1,586	1,468
Numerator	$ (12,075)	$ (9,850)
Weighted average common shares outstanding - basic (in shares)	111,615,839	109,401,383
Basic net loss per common share (in dollars per share)	$ (0.11)	$ (0.09)
Adjustments
Less: antidilutive potential common shares	(29,459,846)	(30,470,089)
Weighted average shares outstanding adjusted for potential common shares	111,615,839	109,401,383
Diluted net loss per common share (in dollars per share)	$ (0.11)	$ (0.09)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	29,459,846	30,470,089
Dividends on Series B Convertible Preferred Stock	$ 1,586	$ 1,006
Accretion of increasing-rate dividend feature	0	462
Total adjustments	1,586	1,468
Net loss available to common stockholders	$ (12,075)	$ (9,850)
Weighted average common shares outstanding - basic (in shares)	111,615,839	109,401,383
Series B Convertible Preferred Stock
Adjustments
Less: antidilutive potential common shares	(27,850,916)	(26,497,570)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	27,850,916	26,497,570
Restricted stock awards
Adjustments
Less: antidilutive potential common shares	(597,805)	(1,629,273)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	597,805	1,629,273
Restricted stock unit awards
Adjustments
Less: antidilutive potential common shares	(822,642)	(1,349,898)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	822,642	1,349,898
Outstanding stock options
Adjustments
Less: antidilutive potential common shares	(188,483)	(964,640)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	188,483	964,640
Performance stock unit awards
Adjustments
Less: antidilutive potential common shares	0	(28,708)
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of earnings per share (in shares)	0	28,708

Equity - Narrative (Details) $ / shares in Units, $ in Millions		3 Months Ended
	Jul. 02, 2020 day director $ / shares	Mar. 31, 2022 USD ($) shares
Dividends Payable [Line Items]
Series B preferred stock, conversion price (in dollars per share)	$ 5.25
Restricted Stock, Restricted Stock Units, And Performance Stock Units
Dividends Payable [Line Items]
Total unrecognized stock-based compensation related to time-based, nonvested restricted stock \| $		$ 30.8
Expenses expected to be recognized over a weighted-average period (in years)		2 years 2 months 26 days
Preferred Class B Convertible Stock
Dividends Payable [Line Items]
Liquidation preference (USD per share)	1,000
Series B preferred stock, conversion price (in dollars per share)	$ 3.85
Series B preferred stock, minimum percentage of conversion stock price to trigger conversion (percent)	770.00%
Number of trading days within consecutive day trading period common stock must exceed trigger conversion price \| day	20
Series B preferred stock, threshold number of consecutive trading days \| day	30
Number of board seats elected by Series B preferred stockholders \| director	2
Series B preferred stock, maximum voting stock percentage on an as-converted basis (percent)	19.90%
Preferred Class B Convertible Stock \| Discounted Dividend Rate prior to Quarterly Dividend Payment ending on June 30,2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)	4.00%
Preferred Class B Convertible Stock \| Perpetual Dividend Rate after Quarterly Dividend Payment ending on June 30, 2021
Dividends Payable [Line Items]
Series B convertible stock, cumulative dividend (percent)	6.00%
Series B Convertible Preferred Stock
Dividends Payable [Line Items]
Dividend in arrears \| $		$ 8.8
Convertible shares issuable (in shares) \| shares		28,262,957

Equity - Changes in Series B Preferred Stock (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares)	100,000
Series B Preferred Stock, outstanding, beginning	$ 92,494
Series B Preferred Stock, outstanding, ending (in shares)	100,000
Series B Preferred Stock, outstanding, ending	$ 92,494
Series B Convertible Preferred Stock
Increase (Decrease) in Temporary Equity [Roll Forward]
Series B Preferred Stock, outstanding, beginning (in shares)	100,000	100,000
Series B Preferred Stock, outstanding, beginning	$ 92,494	$ 91,568
Deemed dividends	$ 0	$ 462
Series B Preferred Stock, outstanding, ending (in shares)	100,000	100,000
Series B Preferred Stock, outstanding, ending	$ 92,494	$ 92,030

- Definition

Carrying amount, attributable to parent, of an entity's issued and outstanding stock which is not included within permanent equity. Temporary equity is a security with redemption features that are outside the control of the issuer, is not classified as an asset or liability in conformity with GAAP, and is not mandatorily redeemable. Includes any type of security that is redeemable at a fixed or determinable price or on a fixed or determinable date or dates, is redeemable at the option of the holder, or has conditions for redemption which are not solely within the control of the issuer. Includes stock with a put option held by an ESOP and stock redeemable by a holder only in the event of a change in control of the issuer.

+ References + Details

Equity - Restricted Stock Awards (Details)	3 Months Ended
Equity - Restricted Stock Awards (Details)	Mar. 31, 2022 $ / shares shares
Restricted stock awards
Number of Shares
Unvested, Beginning Balance (in shares) \| shares	877,197
Granted (in shares) \| shares	0
Vested (in shares) \| shares	(16,001)
Forfeited (in shares) \| shares	(667)
Unvested, Ending Balance (in shares) \| shares	860,529
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share) \| $ / shares	$ 4.26
Granted (in dollars per share) \| $ / shares	0
Vested (in dollars per share) \| $ / shares	3.14
Forfeited (in dollars per share) \| $ / shares	5.12
Unvested, Ending Balance (in dollars per share) \| $ / shares	$ 4.28
Restricted stock unit awards
Number of Shares
Unvested, Beginning Balance (in shares) \| shares	4,228,919
Granted (in shares) \| shares	2,183,670
Vested (in shares) \| shares	(1,553,305)
Forfeited (in shares) \| shares	(46,155)
Unvested, Ending Balance (in shares) \| shares	4,813,129
Weighted-Average Grant Date Fair Value
Unvested, Beginning Balance (in dollars per share) \| $ / shares	$ 8.64
Granted (in dollars per share) \| $ / shares	5.21
Vested (in dollars per share) \| $ / shares	8.18
Forfeited (in dollars per share) \| $ / shares	10.07
Unvested, Ending Balance (in dollars per share) \| $ / shares	$ 7.22

Equity - Stock Incentive Plans (Details)	3 Months Ended
Equity - Stock Incentive Plans (Details)	Mar. 31, 2022 USD ($) $ / shares shares
Number of Shares
Outstanding, beginning of period (in shares) \| shares	1,444,845
Granted (in shares) \| shares	0
Exercised (in shares) \| shares	(124,334)
Unvested options forfeited (in shares) \| shares	(5,000)
Vested options expired (in shares) \| shares	0
Outstanding, end of period (in shares) \| shares	1,315,511
Exercisable options, vested and expected to vest (in shares) \| shares	1,315,511
Weighted- Average Exercise Price
Outstanding, beginning of period (in dollars per share) \| $ / shares	$ 5.18
Granted (in dollars per share) \| $ / shares	0
Exercised (in dollars per share) \| $ / shares	1.33
Unvested options forfeited (in dollars per share) \| $ / shares	7.24
Vested options expired (in dollars per share) \| $ / shares	0
Outstanding, end of period (in dollars per share) \| $ / shares	5.53
Exercisable (in dollars per share) \| $ / shares	$ 5.53
Weighted- Average Remaining Contractual Term (in years)
Outstanding (in years)	1 year 4 months 20 days
Aggregate Intrinsic Value
Outstanding \| $	$ 696,582
Exercisable \| $	$ 696,582

Income taxes (Details)	3 Months Ended
Income taxes (Details)	Mar. 31, 2022	Mar. 31, 2021
Income Tax Disclosure [Abstract]
Effective tax rate	(0.60%)	(0.70%)

Supplemental Disclosure of Cash Flow and Non-Cash Investing and Financing Activities (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Supplemental Cash Flow Elements [Abstract]
Cash paid for interest	$ 1,034	$ 1,094
Income taxes paid	0	4
Non-cash activities:
Right of use assets arising from operating lease liabilities	(37)	0
Right of use assets arising from finance lease liabilities	0	189
Note receivable for sale of property and equipment	0	75
Purchases of equipment in accounts payable	287	159
Fair value of non-cash consideration received for option exercise	0	380
Deemed dividends on Series B Preferred Stock	$ 0	$ 462

Contractual Commitments and Contingencies - Narrative (Details) $ in Millions		3 Months Ended
	Jan. 16, 2019 classAction	Mar. 31, 2022 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Legal and settlement expense		$ 0.3
Number of securities class actions \| classAction	2
Loss Contingencies [Line Items]
Payments for legal settlements		0.4
Insurance Providers
Loss Contingencies [Line Items]
Payments for legal settlements		$ 0.6

Revenue - Summary of Revenue by Product Type (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2022 USD ($) product	Mar. 31, 2021 USD ($)
Segment Reporting [Abstract]
Number of products \| product	2
Revenue, Major Customer [Line Items]
Net sales	$ 58,894	$ 59,967
Advanced Wound Care
Revenue, Major Customer [Line Items]
Net sales	58,449	51,529
Tissue/Other
Revenue, Major Customer [Line Items]
Net sales	52,852	46,569
Cord
Revenue, Major Customer [Line Items]
Net sales	5,597	4,960
Section 351
Revenue, Major Customer [Line Items]
Net sales	377	8,140
Other
Revenue, Major Customer [Line Items]
Net sales	$ 68	$ 298

- Definition

+ References

+ Details

Revenue - Summary of Revenue by Customer Type (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2022 USD ($) distributionChannel	Mar. 31, 2021 USD ($)
Segment Reporting [Abstract]
Number of primary distribution channels \| distributionChannel	2
Revenue, Major Customer [Line Items]
Net sales	$ 58,894	$ 59,967
Direct Customers
Revenue, Major Customer [Line Items]
Net sales	57,473	57,555
Distributors
Revenue, Major Customer [Line Items]
Net sales	$ 1,421	$ 2,412

- Definition

+ References

+ Details