All right, great. Thanks. I'm Ravi Misra on the medtech team here at Truist Securities. Very happy to have Bob Davis from Integra LifeSciences. He's the leader of the Tissue Reconstruction segment at the company. With that, we'll wrap up the conference with our last presentation. Thanks for attending, Bob. Thanks for having me. Not tissue related, overall leadership related at the company. Maybe if you can talk a little bit before we get into it, around what's changed, what hasn't, since Stuart came back to the CEO chair? That's a great first question. Look, I've been at Integra 14 years now, and my first six years I led the global neurosurgery business and now recently, the last seven years with Tissue Reconstruction. I've got a chance to know Stuart Essig quite well, right, as someone who's mentoring and caring. I think the thing that he's jumped right in his 17-day schedule, and very focused around leading in with the comeback with products. We're very focused around customer, getting off our heels, leaning into this. Very big on culture. As you all know, his history at Integra is long. Former CEO, Executive Chair, knows the business as well, knows our people, knows our customers. We've jumped right into this. The other part of this, with some of the appointments with Mike McBreen as chief commercial officer, is something that we've talked about for a while now, is how do we have more one-facing at an enterprise level with our customers? If you look at neurosurgery and specialty surgery, excuse me, and tissue reconstruction, the overlay of those customers and those hospitals are quite aligned. The idea that we can go in with our robust portfolio and really get some contracting power to look a lot like a large global med tech, because those customers want to have less vendors to deal with. I'd say with Stuart, the change has been around that, leaning in and getting our confidence back in there with our customer base to win them back. Yeah. Just on that front, regarding that one face to the client, any early green shoots on that that you're seeing in tissue, at least in your organization, on your- Yeah Purview? No. Look, for us, we've had a product called PriMatrix that has come back. Obviously, we had some products that were challenged over the last couple of years. We've brought PriMatrix back into the market late Q4. The customer reception has been quite strong and we're very excited about that. Our goal is to win back about half of that revenue base in 2026, and we're on pace to do that. We focus very much on our customer install base for PriMatrix. We went at customers, our largest customers that ordered PriMatrix starting on the burn side, to displace some of the low-cost providers or competitors that had gotten in. That's also been great, and now we're working our way across the board because now we have a portfolio to play. That's helped pull some of the other products in as well. We're broadening out into trauma. PriMatrix has some very unique clinical differentiation and a lot of clinical evidence. It does well in certain procedures where they may see that patient once. We've gotten some good input from our surgeon base as well on that. Overall, it's been very impactful from a standpoint of pulling the portfolio forward and letting customers know that we're back. Yeah. I think that's been a big thing. Just when it comes to tissue recon, you have a broad set of offerings across the portfolio. Maybe if you'd use this opportunity to help us understand the TAM, the various kind of components of it, and the growth rates of each CAGRs of those segments. Yep. The markets that we play in, the addressable markets, are about $2.5 billion-$3 billion. If you think about skin substitutes, it makes up about $1.6 billion a year in skin substitutes, of which there's over 250 companies in there with various products. If you look at implant-based breast reconstruction, of which we have pending PMAs, I'm sure we'll talk about, and the hernia market, that's about another $1.1 billion. Think about between $2.5 billion-$3 billion focused around burn and trauma, plastics, hernia, and soon to be for us, implant-based breast reconstruction. Your presence has been stronger, I guess, in the inpatient setting. Yeah Somewhat insulated from the CMS changes to the ASCs and office-based payments and wastage. You do have some exposure there. Can you maybe talk about that market a little bit and what you're seeing? Are you seeing procedures shift in terms of site of care? Are you seeing a wait and see approach, inventory work down in that space? Yeah. No. It can get quite complex, my goal would be to just keep it simple. I'd say for us, our business is focused 85%-ish around inpatient reimbursement in that skin substitute space. That represents the DRG space. That was untouched by the recent CMS changes. If you think about where our teams are, they are in those IDNs, they're in those hospitals, they're focused around inpatient. While we're in there, those procurement centers are also buying for hospital outpatient as well as their wound care clinic. 70% of the wound care clinics in the U.S. are owned by those hospitals and those IDNs. I would say in that part of the business Inpatient and DRG grew double digit that we saw in Q1. That seems to be quite robust. I'd say we're very cautious around hospital outpatient and the wound care clinic in that IDN space. It's slowed down. It's disrupted a bit from a standpoint of, I think, customers trying to figure out the reimbursement. We're watching that one, and we're in there. If you shift over to the other sites of care, physician office has been impacted significantly. I don't think that's new news. As well as some of those ambulatory surgical centers as well. That is not a strategic play for us, but obviously we're watching it. We do think there could be opportunity there one day for us to leverage some of the things that we have that CMS provides, and I'm sure we'll talk about that. That's how we look at the market, right? We're trying to figure out from an IDN perspective, we're spending a lot of time educating those customers in the hospital around what that means for their outpatient ORs and their wound care clinics because there's an underlying clinical demand for that space. Got it. There's been also a lot of kind of just manufacturing dynamics in the tissue recon space, kind of idiosyncratic to Integra. As those products start returning to market, you have new facilities hopefully coming on, I guess now, right? Yep. Sometime now. As that comes back, help us kind of frame what the long-term kind of sustainable growth profile of this business looks like. Maybe couch it against where you think the market is growing. Mm-hmm. Yeah. If you look at our guidance this year, right, we are quoting mid-single digits for tissue reconstruction business, and we're confident that we will achieve those targets. If you look at the markets themselves, that addressable market, we have growth that swings anywhere from lower single to mid-single digits, say around burn, up through double-digit growth in implant-based breast reconstruction. That market demand remains and continues. Again, I think the CMS on the skin substitute space will have impact, but not necessarily where we play. I think we're excited about the markets we're in. They're niched markets that we've spoken about before, and there's high barriers of entry. When you think about where we are, even from a CMS perspective or bringing SurgiMend back, we expect to be operationalizing our new Braintree plant at the end of this month. We'll be building product and launching SurgiMend in mid Q4. Yeah. I think one of the areas that we've been thinking about with our thesis is these are products that have been off the market now for a couple of years. Yeah. What gives you the conviction that there hasn't been kind of structural damage, I guess- Yeah To the relationship between you and the customer since that's been- No, it's fair. Again, we have not stepped back from our customer base. As I said, we have a portfolio of products, right? We have Integra Dermal Regeneration Template, PriMatrix, MicroMatrix, Cytal. We have various products in the wound reconstruction or tissue and burn space. We have products called DuraSorb for plastic reconstructive surgery and a product called Gentrix for hernia. Our teams have been calling on our customers, right? They didn't leave us, we left them a bit with some of our portfolio and some of the challenges that we had. We've kept in constant contact with them, letting them know when we're coming back. It's going to be challenging, right, but we're measuring that with our customers. With PriMatrix, we understood where we were going to go first. We talked to those customers. We let them know we were coming back. We've had good response there, and we're talking about recovering about 50% of that this year. I think we'll do the same as we get closer for SurgiMend. We know exactly who the high users are, we know where they are in plastics, and we know where they're used in hernia. We're going to take the same stated approach. Again, it'll be challenging, but I would say the underlying clinical differentiation surrounding a product like SurgiMend PRS still remains, right? The tensile strength, the revascularization properties of that product still remain, and we're seeing that with PriMatrix as well as we're coming back into the market. I don't think we're going to win 100% of all those customers back, but we're going to win with new customers as well. We've had very good response with them. When we get in with those customers, like I said, we haven't left them, so we'll remain in there to learn more as we come back to market. I guess, just in terms of the guidance, just tying it back to the guide your mid-single digit approach for the business. Yep This year, how much of that is based on the return of SurgiMend, or is that kind of pure upside to the model? Yeah, look, I would say we're being very conservative right now to make sure that we deliver and execute. Right now for Q4 with SurgiMend, it's quite minimal. In the return there. Then for 2027, as we come back to market, we'll offer more guidance around that. We are, again, starting with we've been out of the market three plus years and understand that. I think as we divvy this space up between plastics reconstructive surgery and then into hernia, the 2027 guide will really be bolstered by our PMAs that we have in play as well. Yeah. We have PMAs in play for SurgiMend, and we're expecting approval there in 2027 as well as DuraSorb in 2027. The SurgiMend ramp will be bolstered by those PMAs in 2027, so that'll help with that ramp. We'll be the first company in the market with a PMA-approved product for implant-based breast reconstruction for safety and efficacy, and that will be a big deal to that space. Yeah. Is there market development required to go after the revenue opportunity there, or is it already in existing accounts? Yeah. No, it's absolutely. Again, we're unable to promote. One of the things that a PMA will allow us to do is to promote in the OR with surgeons, professional education, and be part of that procedure training. That's all in the plans. Part of our plans today is to have those customer-facing activities. We already have our plans to ramp up our sales force, which are already in budget and part of the guidance for next year. The plans are underway. We're working on that, as I said, as we get closer for 2027 PMAs. Yeah. It's a pretty substantial market expansion for you into that IBR space. Just how should we think about maybe the drop-through to profitability if that kind of plays out- Yeah As we think it's going to? Yeah. If you think about as we come back to market with SurgiMend, one of the things that's quite interesting, I haven't seen anything like this, we're returning to market as a 510(k). We don't promote in implant-based breast reconstruction, but the significant part of those procedures, the surgeons are using in that space. We'll get a good idea of surgeon without promoting in our pivot strategy. As we move into the PMA, that's really going to help us with think about two products. One, a biologics that's going to have a distinct profile for what the surgeons will use with that surgeon type, as well as a resorbable synthetic in DuraSorb that will also have PMA, that they'll have another distinct profile that they can go at it. The portfolio play really is a huge cost of sales savings for us as well. If you think about SurgiMend, to answer your question, we were running at about $35 million-$40 million a year in SurgiMend. Again, a higher margin product of profitability. As we ramp up, that will offer that guidance in 2027 to return to profitability. You basically said recovering 50% of that, so about, what, $18 million? For PriMatrix. Oh, sorry. That's the model that we're using today, but again, not committing to that, but we're going to take that same approach. A lot of pre-work was done with that installed base. As we're calling those customers back now, we'll have a good indication of what's the proper rate of recovery with that customer base. Do you think it's unreasonable for us as we think about our models for 2027 to put in 50% recovery? I don't. After a full year, I don't think it is. Okay. Hernia, breast expansion, doesn't sound like a different call point is required here. You're going through a GPO here or. Yeah. Our call point that we focus on primarily is plastic reconstructive surgery for implant-based breast reconstruction or anything in plastics relative to soft tissue reinforcement where weakness exists. You have one or two call points in that hospital that that team's already on. Remember, this is a business that sold SurgiMend PRS and hernia before it left the market. We know how to do it. Typically in that marketplace, vendors will carry both. The customers buy similarly in effect of when they come under contract, they're looking for plastics reconstructive surgery as well as hernia. In the same purchasing contract. I think it's back to my earlier, Ravi, where it gets back to my earlier thing about bringing all that together with an Integra Skin, a PriMatrix, and some of the products over in specialty surgery to really get some contracting power there. Okay. Then just on maybe on Braintree. Can you just talk to investors about the investments that are going into place that were, I guess, booked in SG&A that are now kind of looping into COGS as you go active on that? How should we roll that up into the broader margin story for the share run? Yeah. I think it'll be a bit dilutive coming to market with Braintree. Right now we have a vendor pulling on PriMatrix with healthier margins and with more volume. We'll get accretive to the company with Braintree. I think that's the goal. Volume will drive a big part of that. Coming back to market as a 510 with that ramp and seeing that reception and then moving into the PMA, we'll return to healthier margins with that product. Just with PriMatrix, that dual source strategy. That was something laid out last year as you came back to market. How long would you plan on continuing that? Is there a, "All right, we don't need it anymore, but we're just going to hold onto it," or what's the thinking there? No, listen. Our goal is not to talk about Braintree too much in the future, right? Let's get the plan up and running. Let's be shipping product. Let's get healthy about it. I think for us, the dual source strategy is something that we have as a company mantra to make sure that we're protecting ourselves with primary and secondary suppliers across the board. It's something, the lesson learned, and that's something that we're going to pursue. No. I think longer term, we'll continue to have secondary suppliers across the businesses. Not only just PriMatrix, but yeah. Correct. Yep. Just more redundancy. Across the biologics, et cetera. Okay. MediHoney was another kind of product that I guess a few months back, that was something that was taken off the market. Yep. Just level set us, I guess. What was the revenue and growth of that business? Yep. Again, we had a voluntary recall at the end of Q1 in 2025, MediHoney is an interesting business for us. Has a strong brand recognition with our customer base. It's a wound dressing that has over 40 scientific papers. Not all medical grade honey is created the same. One of the products that customers are continuing inquiring when it's returning. The product was around $35 million-$40 million a year annualized. Again, we're going to take that same stated approach, coming with a condensed level of SKUs. The goal is in 2027, we'll be returning to market there. We'll start in the U.S. and work our way back into Europe, where we had some significant international revenues. It's a great business, and it really helps if you're in that wound side of the business. It has a lot of recognition in that space, and it works. We're excited to get and be investing in that. I think we talked about that on the last earnings calls that we announced that we'd be bringing that back to market. These various products that are coming back to market, just similar types of contribution margin to the broader Integra? Yeah, from a MediHoney perspective, look, when you get into the biologics and those higher margin products, it doesn't have that level. It's not dilutive to the company, MediHoney. It brings us in a new set of customers that we want to maintain contact with. We have other products like Total Contact casting that are frontline defense for diabetic foot ulcers. As I think the government has really reinforced pricing and initial standards of care, we'll see that in DFU in the wound care market. We think there's upside there. Yeah. Then just, I guess the other part of your tissue business on the private label side. Some easy comps, I guess, you're against, but you still grew nicely in the first quarter. Yeah. How should we think about this business on a go-forward basis? Yeah, look, it's a choppy business and we had some good guys in Q1 and a lot of that is around capacity and matching that. I think in the back half of the year, we'll look to be flattish for the year in private label. It's a strong profit business for us across the company. It's less about growth and more about the profitability. Again, it gets back to sourcing and taking care of our corporate partners as well, that we're really focused around. We have a few very large customers of ours, so it's been about stability of execution on those products for private label. Again, we remain committed to private label. Got it. Okay. One of the things that we've been asking each company here is just following concerns on ACA volumes or ACA subsidy expirations and hospital commentary around volumes. Just what you've been seeing in the field on your end, either in tissue or if you can comment on the broader Integra business. Any impact there? Yeah, you almost want to go down in it vertically. You look at trauma one way, you're looking at plastics, you're looking at implant-based breast reconstruction and hernia. I think I talked about in the CMS, that skin substitutes, pretty robust in hospital. I think we see cautious in the outpatient in the hospital, and then we see a most definite downturn around physician office in that outpatient arena. That I would heavily agree with. I think in the procedures around plastics reconstructive surgery, we're not seeing anything that would indicate a procedure turndown in the plastic side of that space. Yeah. I want to return a little bit more back to that ASC around, you're seeing a lot of maybe the ankle biters in the space fall out given the reimbursement changes. Doesn't seem to be a strategic focus for Integra. Yeah. Potentially one where you could be. What would cause you to be more excited or get more competitive in that space? Yes. Given that your economics seem- Yeah Pretty good to play in the $127 environment. I think the CMS part that gets us excited, if you think about the waste and fraud that they wanted to take out, and I think they've accomplished that. We'll see. As soon as you bring the patient to front and center about closing wounds, that's where I think we'll come into play. We're very strong with our clinical evidence. We have a portfolio of products that we're investing heavily on clinical evidence. Our pricing, we didn't have to change at all. We didn't have to make any price concessions there. We have various sizes across the portfolio. You're hearing a lot of different terminologies around the government only reimbursing for the size of the wound, et cetera. We totally support. Now customers have the ability to do all that with us. I think when the dust settles, if you go over to physician office, we'll watch and see, to see if there is a place for us to go there, and we'll be able to take advantage of that opportunity. What I'm most interested in is getting our customers in the hospital educated as fast as we can around outpatient and wound care clinic, because they have that underlying demand. We have a complete portfolio to work with them. I guess just on that front, the converse would be, are you seeing peers that were focused on the in-office space trying to move into, I guess, onto your turf? The outside-in approach is not new. It's a pretty high barrier of entry if you think about access into the hospital, access into procurement, the other vendors that are in there in a very strong contracting way, VAC committees, et cetera. It's a really tough thing to just say, "Hey, I'm going to go over here to the hospital space" and unseat. You have to have some good reasons why that would happen. It's not that it hasn't. Again, a lot of vendors are going to exit the space because of the economics now, and I think that's a good thing. I think it's a good thing. We had 250 products in one space that had varying degrees of clinical evidence or impact. I think it's a good thing to make it about the patient and patient closure. Got it. You presumably have the scale across the businesses to help defend against that as well. Correct. Okay. That's the list of questions for me. I think we can finish it a little bit earlier on then, Bob, thank you so much for your time. No, thank you. Yeah. Enjoyed it. Appreciate it. Okay. Take care. Thanks.