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Plastics

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Plastics

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    • 1. EVICEL Fibrin Sealant (Human) Product Information EVICEL TM Fibrin Sealant (Human) PSR Sales Training Module
    • 2. Training Road Map
      • Biosurgicals Overview
      • Fibrin Sealant Market Overview
      • New Indication
      • Promotional Roadmap & HCC
      • EVICEL Product Training
      • Procedural Targets
      • Sales Tools
      • EVICEL in Plastic Surgery Procedural Training
      • Q&A
      • Review Game
    • 3. Biosurgicals Products EVICEL* FIBRIN SEALANT (HUMAN) ORC (Oxidized Regenerated Cellulose) GELATIN FLOWABLE GELATIN COLLAGEN FIBRIN SEALANT SURGICEL* Hemostats SURGICEL FIBRILLAR* Hemostats SURGICEL NU-KNIT* Hemostats SURGIFOAM* GELATIN SPONGE & POWDER Hemostats INSTAT* MICROFIBRILLARCOLLAGEN Hemostats SURGIFOAM* POWDER Kit SURGIFLO* Hemostatic Matrix THROMBIN EVITHROM* Thrombin, Topical (Human)
    • 4. Fibrin Sealant Market Overview
    • 5. U.S. Fibrin Market *IMS Data, 2007 Vitagel EVICEL Tisseel 2006 Fibrin Market ($92 MM) 2007 Fibrin Market ($103 MM est.) Total fibrin market grew by 12% in 2007 Source: IMS 2007
    • 6. EVICEL Performance 2005 $183,364 $847,628 $1.2MM $1.9MM $2.2MM $2.2MM $3.1MM $3.6MM $4.2MM $5.3MM Launched EVICEL Launched CROSSEAL Launched EVICEL Vascular 2006 2007 $6.1MM $8.4 MM $7.1 MM Launched EVICEL General Hemostasis $8.8MM 2008 $10.4MM YTD in 2007 vs $17.7MM YTD in 2008 70% growth over 2007!!!
    • 7. 122% -15% 37% The Fibrin Sealants segment increased 18% over previous quarter and 14% over 4Q ’06 to $27.3M this quarter. Evicel leads the growth, with almost $5M growth in the past year and $0.7M in the past quarter. Although Tisseel is down over the past year, it rebounded in 4Q ’07 after its drop in 3Q ’07. Tisseel is cannibalizing its VH (nonfrozen) business with the newer frozen formulations which now account for 22% of its total dollar volume US Biosurgicals Market: Fibrin Sealants Detailed Segment, Short-term Dollar Performance 3 Month Quarters, $ Volume, in Millions Growth over Pr. Yr. Segment Volume (MM) $3.9 $5.8 $8.2 $8.3 $8.8 $17.0 $17.5 $14.3 $11.4 $12.0 $3.5 $3.4 $2.9 $3.5 $4.0 $- $5 $10 $15 $20 $25 $30 4Q '06 1Q '07 2Q '07 3Q '07 4Q '07 $, Millions Evicel Tisseel Vitagel Source: IMS HIS Data Compiled by: Pinky Shaw, BIWW
    • 8. Plastic/Burn Surgery Market Overview **NOTE: As always, promotion only for on-label surgeries for hemostasis $764MM 1,038,000 TOTAL $338MM 735,000 Breast (Reconstruction, Lift, Reduction and augmentation) (5 mL) $100MM 100,000 Burn Surgery (10 mL) $240MM 160,000 Abdominoplasty (15 mL) $86MM 43,000 Massive Weight Loss Body Contouring (20 mL) Potential Market (100% Penetration) Volume Procedure
    • 9. Procedures to Target
      • Breast Reconstruction (reimbursed) with Flaps (TRAM, Lat, etc.)
      • Abdominoplasty
      • Massive Weight Body Contouring Procedures
      Plastic Procedures
    • 10. Background & New Indication
    • 11. J&J Collaboration Framework
      • Create a unified J&J presence and set of product-based solutions to the Plastic Surgery community
    • 12. EVICEL General Hemostasis Indication Expected in January 2008
      • Background on “General Hemostasis”
        • Fibrin Sealants regulated as a biologic product by the FDA
        • Historically, an RCT required per indication (specific surgical site and application)
        • FDA revised guidance to allow for a “general hemostasis” claim if efficacy could be demonstrated in a “variety of surgical settings”
        • General hemostasis does not include sealing, tissue/prosthetic attachment or adhesion prevention  specific trials needed for these indications
    • 13. New Opportunities in Plastic Surgery
      • Expanded indication provides opportunity for promotion in Plastic Surgery for hemostasis
      • Fibrin sealants (largely TISSEEL) used in breast reconstruction and augmentation, massive weight loss body contouring (MWLBC)
      • Specific applications include hemostasis (on-label) , sealing, tissue attachment, and adhesion prevention
    • 14. EVICEL Selling Cycle
      • Surgeon trial & usage in OR necessary to drive adoption
      • Reps train nurses and surgeon on preparation & application and support materials management for handling product
      • May require P&T committee review and/or new product committee via materials management
      • Typical cycle may be ~1-3 months
      • 3 purchases good indicator of a conversion
      • New account conversions driving growth
      • Current focus on share capture from Tisseel
    • 15. New Indication for EVICEL TM EVICEL TM Fibrin Sealant (Human) is indicated as an adjunct to hemostasis for patients undergoing surgery when control of bleeding by standard surgical techniques is ineffective or impractical * Pending final labeling from FDA
    • 16. EVICEL ™ Fibrin Sealant (Human) Original Promotional Road Map Does the surgeon operate on the liver? Sales rep can also respond to a training request Sales rep or Medical Affairs * can respond to request for clinical info. Yes Yes You and the customer can initiate questions on EVICEL Fibrin Sealant (Human) for the approved indication Can you (sales rep) initiate conversation on EVICEL Fibrin Sealant (Human) for the approved indication? Can you (sales rep) respond to clinical questions on EVICEL Fibrin Sealant (Human) for the approved indication? Yes Only customers can initiate questions on EVICEL Fibrin Sealant (Human) No Only Medical Affairs * can respond to request for off-label clinical information on fibrin glue Sales rep could provide proper usage instructions upon request (including indications & safety information) to customers who decide to use the product Can you (sales rep) respond to off-label clinical questions on EVICEL Fibrin Sealant (Human)? Can you (Sales rep) initiate conversation on EVICEL Fibrin Sealant (Human)? No Training should include Indications, Contraindications, Precautions, Warnings, and the technical aspects of the product. * Pending final labeling from FDA No
    • 17. EVICEL ™ Fibrin Sealant (Human) Vascular Promotional Road Map Does the surgeon operate on the liver or perform vascular surgery? Sales rep can also respond to a training request Sales rep or Medical Affairs * can respond to request for clinical info. Yes Yes You and the customer can initiate questions on EVICEL Fibrin Sealant (Human) for the approved indication Can you (sales rep) initiate conversation on EVICEL Fibrin Sealant (Human) for the approved indication? Can you (sales rep) respond to clinical questions on EVICEL Fibrin Sealant (Human) for the approved indication? Yes Only customers can initiate questions on EVICEL Fibrin Sealant (Human) No Only Medical Affairs * can respond to request for off-label clinical information on fibrin glue Sales rep could provide proper usage instructions upon request (including indications & safety information) to customers who decide to use the product Can you (sales rep) respond to off-label clinical questions on EVICEL Fibrin Sealant (Human)? Can you (Sales rep) initiate conversation on EVICEL Fibrin Sealant (Human)? No Training should include Indications, Contraindications, Precautions, Warnings, and the technical aspects of the product. * Pending final labeling from FDA No
    • 18. EVICEL ™ Fibrin Sealant (Human) General Hemostasis Promotional Road Map Sales rep or Medical Affairs can respond to request for clinical info. Yes Yes You and the customer can initiate questions on EVICEL for the approved indication Can you (sales rep) initiate conversation on EVICEL for the approved indication? Can you (sales rep) respond to clinical questions on EVICEL for the approved indication? Only customers can initiate questions on EVICEL for off-label uses No, cannot promote for off-label uses, such as sealing and fixation Only Medical Affairs can respond to request for off-label clinical information on fibrin glues Can you (sales rep) respond to off-label clinical questions on EVICEL Fibrin Sealant (Human)? Can you (Sales rep) initiate conversation on off-label uses? No Training should include Indications, Contraindications, Precautions, Warnings, and the technical aspects of the product. Promote On-label for Hemostasis? Does the surgeon perform surgery? Yes * Pending final labeling from FDA No
    • 19. Customer Requests for Clinical Information
      • Utilize Medical Affairs for specific requests for:
        • Off-Label uses for EVICEL™ (Sealing, Gluing, Fixation, etc..)
        • Requests for Clinical Data for specialties that were not studied in our 3 clinical trials (Liver, Vascular & Soft Tissue)
      • Customer can request clinical information by:
        • Filling out Post Card (Lit Depot code: DHM0045)
        • Calling: 800-888-9234, ext 3800
        • E-mail: [email_address]
      • Off-Label examples:
        • Does EVICEL reduce seromas?
        • Does EVICEL seal or fixate tissue?
    • 20. Leverage our Broad GH Indication Retroperitoneal Bleeding/Soft Tissue (3) Peripheral Vascular Surgery (2) Liver Resection Surgery (1) General Hemostasis Indication Studied in 3 different tissue types
    • 21. Soft Tissue Study Highlights ENDPOINTS / CONCLUSIONS
      • 135 subjects (11 pediatric) in 18 sites
      • Time to hemostasis (TTH) – target bleeding site at 4, 7 & 10 mins
      • 95.5% vs. 81.2% achieved hemostasis by 10 min
        • Confirming that EVICEL™ is superior to SURGICEL (p<0.05)
      • 75.8% vs. 53.6% achieved hemostasis by 4 min
      * Pending final labeling from FDA
    • 22. Competitive Overview
    • 23. US Indications Differ by Fibrin Sealant Brand 1, 2 - Sources: US FDA Approved Package Inserts for Tisseel, Evicel TM & Artiss Note: Information from respective prescribing information derived from separate clinical studies - not intended to convey comparative safety or efficacy.
      • TISSEEL is indicated for use as an adjunct to hemostasis in surgeries involving cardiopulmonary bypass and treatment of splenic injuries due to blunt or penetrating trauma to the abdomen, when control of bleeding by conventional surgical techniques, including suture, ligature, and cautery, is ineffective or impractical; TISSEEL is a satisfactory hemostasis agent in fully heparinized patients undergoing cardiopulmonary bypass; TISSEEL is not indicated for the treatment of massive and brisk arterial or venous bleeding
      • TISSEEL has been shown to be an effective sealant as an adjunct in the closure of colostomies 2
      TISSEEL (Fibrin Sealant) Pre-Filled Syringe (Frozen) (Baxter) Indication Statements
      • ARTISS is indicated to adhere autologous skin grafts to surgically prepared wound beds resulting from burns in adults and pediatric populations
      • ARTISS is not indicated for hemostasis 2
      ARTISS (Fibrin Sealant) (Baxter) Product
      • Adjunct to hemostasis for use in patients undergoing surgery, when control of bleeding by standard surgical techniques is ineffective or impractical 1
    • 24. Indications by Fibrin Sealant Sources: US FDA Approved Package Inserts for Tisseel, Evicel TM & Artiss Note: Information from respective prescribing information derived from separate clinical studies - not intended to convey comparative safety or efficacy. To adhere autologous skin grafts to surgically prepared wound beds resulting from burns Adjunct to hemostasis in patients undergoing surgeries involving Cardio- pulmonary bypass
      • .Adjunct to hemostasis in patients undergoing surgeries to treat splenic injuries due to blunt or penetrating trauma
      • Sealant as adjunct in closure of colostomies
      TISSEEL Not indicated for hemostasis ARTISS Adjunct to hemostasis for use in patients undergoing surgery Ortho Burns Plastics GYN Urology CV PV General
    • 25. Fibrinogen & Thrombin Content*
      • Thrombin
        • 800-1200 IU/mL
      • Fibrinogen
        • 55-85 mg/mL
      • Thrombin
        • 400-625 IU/mL
      • Fibrinogen
        • 67-106 mg/mL
      • Aprotinin
        • 2250-3750 KIU/mL
      *EVICEL TM Fibrin Sealant (Human) Artiss & Tisseel Fibrin Sealant Package Inserts 1. Sierra D. Fibrin sealant adhesive systems: a review of their chemistry, material properties and clinical applications. Journal of Applied Biomaterials. Vol.3. 1992: 147-151. Note: Not intended to convey comparative safety or efficacy. EVICEL TM Fibrin Sealant TISSEEL Fibrin Sealant
      • Thrombin
        • 2.5-6.5 IU/mL
      • Fibrinogen
        • 67-106 mg/mL
      • Aprotinin
        • 2250-3750 KIU/mL
      ARTISS Fibrin Sealant EVICEL TM does not contain aprotinin and does not expose patients to the risks associated with aprotinin EVICEL TM does not require an antifibrinolytic stabilizer (ex: aprotinin) agent due to the removal of plasminogen from its formulation Normal fibrin clot is produced with approximately 2–5 mg/mL of fibrinogen 1
    • 26. Clot Longevity Comparison* Longevity of the EVICEL TM Fibrin Sealant (Human) clot in vivo is comparable to that of CROSSEAL* Fibrin Sealant, and other marketed fibrin sealants such as Tisseel *Johnson & Johnson Wound Management Data on File, Data from in vitro animal model
    • 27. EVICEL TM Product Training
    • 28. Think EVICEL TM for your Plastic Surgery Procedures EVICEL TM is the first and only fibrin sealant approved for general hemostasis in surgery 1 TRAM Flap Abdominoplasty Think 1. Full Prescribing Information.
    • 29.
      • Not indicated for the treatment of severe and brisk arterial bleeding.
      • EVICEL TM is contraindicated in individuals known to have anaphylactic or severe systemic reaction to human blood products.
      • Because this product is made from human plasma it may carry a risk of transmitting infectious agents, such as viruses, and theoretically, the Creutzfeld-Jakob (CJD) agent.
      • Anaphylactic reactions may occur.
      • In liver surgery, bradycardia occurred more frequently in the fibrin sealant group.
      • Please see sales representative for Full Prescribing Information
      EVICEL™ Fibrin Sealant (Human) INDICATION: An adjunct to hemostasis for use in patients undergoing surgery when control of bleeding by standard surgical techniques is ineffective or impractical Important Safety Information
    • 30. EVICEL™ Fibrin Sealant (Human)
      • EVICEL TM is the first and only fibrin sealant approved as a general adjunct to hemostasis in patients undergoing surgery
      • EVICEL TM does not contain aprotinin or bovine derivatives 1 and does not expose patients to the risks associated with aprotinin 2
      • Needle-free device eliminates the risk of needle-stick injuries
      • Double-viral inactivation / removal procedure designed to reduce the risk of viral transmission 1
      A safe and effective all-human fibrin sealant that doesn’t require an antifibrinolytic agent, while maintaining clot stability 1. Full Prescribing Information. 2. Data on File. ETHICON, INC.
    • 31. EVICEL™ Fibrin Sealant (Human)
      • Ready to use in less than one minute after thawing 1,2
      • Clog-resistant triple lumen catheter design eliminates the inconvenience of switching tips
      • Standard 7cm, 45cm and 35cm Rigid Tips designed to resist clogging
      Hemostasis can begin quickly with less preparation time and minimal clogging Triple-lumen tip — resists clogging 1. Full Prescribing Information. 2. Data on File. ETHICON, INC. Thaws within 10 minutes at 37 0 C; within 1 hour at 20 0 C to 25 0 C (room temperature); or within 1 day at 2 0 C to 8 0 C (refrigerator).
    • 32. EVICEL™ Fibrin Sealant (Human)
      • Forms an elastic clot that anchors firmly to the bleeding site 2
      • Sprays or drips for broad or targeted application 1
      • 5 mL provides 100 cm 2 coverage area 1
      • Provides clear visibility of the bleeding site so you can quickly assess hemostasis 2
      • EVICEL TM maintains clot stability over time comparable to other fibrin sealants, without the need for an antifibrinolytic agent 2
      Designed to keep you focused on your procedure – Clear and stable clot 1 1. Full Prescribing Information, see EVICEL TM Package Insert 2. Data on File. ETHICON, INC.
    • 33. Biologics – Thrombin & BAC2 1
      • Can be stored at:
      • -18°C or colder for up to 2 years
      • 2°- 8°C for 30 days
      • Room temperature for 24 hours.
      • Can be thawed in:
      • 10 minutes in 37°C water bath
      • 1 hour at room temperature
      • 1 day at 2°- 8°C in refrigerator
      1. Full Prescribing Information.
    • 34. Device Overview 2 luer locks for easy removal and attachment of accessory tips Triple lumen 7cm clog resistant applicator tip Optional 35cm Rigid Tip Can be sprayed or dripped from the same device
    • 35. 35 cm Rigid Tip Overview EVICEL 35 cm Rigid Tip Packaging (3 per box) Ready to spray or drip One-Handed delivery Atraumatic & clog-resistant tip (triple lumen runs throughout tip) Attaches easily to the device
    • 36. Pressure Regulator EVICEL TM Fibrin Sealant (Human) should be sprayed using an air pressure of 20–25 psi measured by air flow* * EVICEL TM Fibrin Sealant (Human) Pressure Regulator Instructions for Use
    • 37. Preparation Video
    • 38. EVICEL™ Fibrin Sealant (Human) Summary 1
      • All Human, manufactured human plasma-derived components, aprotinin & bovine-free
      • Easy preparation with no reconstitution required
      • Ready to use in less than a minute
      • Spray or drip with same device
      • Clear elastic clot
      • Tri-lumen tip, clog resistant applicator
      1. Full Prescribing Information.
    • 39. Plastic Surgery Sales Tools
    • 40. Updated Main Sales Aid NOW the only fibrin sealant approved for general hemostasis in surgery New Effective Bullet: Proven Rapid Hemostasis in vascular, urologic, gynecologic and general surgery New Soft Tissue Study data in general, gynecologic and urologic surgery * Pending final labeling from FDA; Draft Piece-Subject to change
    • 41. New Plastics Slim Jim Plastics Images (Breast Reconstruction) Hemostatic Efficacy (New Soft Tissue Study Data) in general, gynecologic and urologic surgery Experience the clear choice for your plastic surgery procedures Spray or drip EVICEL™ to achieve hemostasis during reconstructive procedures, including: breast reconstruction, abdominoplasty, facial reconstruction and vascular anastomoses * Subject to FDA Review * Pending final labeling from FDA; Draft Piece-Subject to change
    • 42. Customer Requests for Clinical Information
      • Utilize Medical Affairs for specific requests for:
        • Off-Label uses for EVICEL™ (Sealing, Gluing, Fixation, etc..)
        • Requests for Clinical Data for specialties that were not studied in our 3 clinical trials (Liver, Vascular & Soft Tissue)
      • Customer can request clinical information by:
        • Filling out Post Card (Lit Depot code: DHM0045)
        • Calling: 800-888-9234, ext 3800
        • E-mail: eth_medical_info@ethus.jnj.com
    • 43. Product Preparation Poster New Cling-zee OR Wall Poster Easy preparation: No mixing required New easy-to-see images Preparation instructions for the 35 cm Rigid Tip
    • 44. EVICEL Product Codes
    • 45. New Customer In-service Deck (Updated with new indication & modular device) New Updated Website (New specialty tabs in Ortho, Burns & Plastics) New Blackberry Videos (3 new videos in Ortho, Burns & Plastics)
    • 46. EVICEL in Plastic Surgery Overview
    • 47. Plastic & Burn Specialty Overview
    • 48. Why I Use Fibrin Sealants
      • Hemostasis: (on-label)
      • Bleeding most common complication after most plastic surgical procedures
      • Hematoma can be devastating complication 
      • Can lead to skin flap loss, loss of skin graft, thrombosis of vascular anastamosis
      • Sealant: (off-label- Must send requests to Med Affairs)
      • Oozing from tissue bed can lead to seroma formation
        • Lymphatics
        • Capillaries and small vessels
      • Seroma can lead to infection, cosmetic deformity, reoperation
    • 49. Where I Use Fibrin Sealant
      • Under all skin grafts to prevent shearing
      • Underneath all flaps prior to inset for better flap adherence
      • Under flap donor sites
      • On top of skin graft donor site prior to dressing placement
      • Any large open raw surface area where bleeding / oozing is a concern
    • 50.
      • Incision  
      Abdominoplasty Steps of Procedure & Bleeding Challenges
    • 51. Abdominoplasty
      • Steps of Procedure & Bleeding Challenges
      • Incision  
      • Dissection of skin from abdominal wall tissue
        • Oozing from tissue bed
        • Large number of lymphatics and small vessels transected
      • Abdominal muscles tightened
      • Excess skin is excised
      • New naval opening created
      • Drains placed
      • Application of EVICEL™ Fibrin Sealant (Human) and closure
    • 52. Breast Reconstruction – Flap
      • Steps / Bleeding Challenges
      • TRAM flap donor site very similar to abdominoplasty
      • Latissimus dorsi flap leaves large surface area cavity in upper back
      • Flap incision
      • Dissection of skin from abdominal wall or back
      • Elevation of muscle from its normal anatomic position and rotation up onto chest to create breast
      • Fascia closed
      • Drains placed
      • New naval opening created
      • Application of EVICEL™ Fibrin Sealant (Human) and closure
    • 53. Breast Reconstruction – Implant
      • Steps / Bleeding Challenges
      • Usually immediately after mastectomy so incision not needed
      • Pectoralis muscle elevated, pocket created
      • Implant placed
      • Pectoralis closed – primary or graft
      • EVICEL™ Fibrin Sealant (Human) placed under pectoralis muscle
      • Drains placed
      • EVICEL™ and skin closure
    • 54. Facial Surgery
      • Steps / Bleeding Challenges
      • Head and neck extremely vascular
      • Facelift, Craniofacial surgery
      • Incision
      • Thin facial skin flap elevated – hematoma devastating
      • Muscle layer elevated and plicated – parotid gland
      • Extra skin excised
      • Drain placed
      • EVICEL™ Fibrin Sealant (Human) and skin redraping and closure
    • 55. Scar Revision
      • Small scar turns into large surface area wound when scar excised
      Bleeding Challenges
    • 56. Scar Revision
      • Steps
      • Incision and excision of scar
      • Grafts harvested – donor sites sprayed with EVICEL™ Fibrin Sealant (Human) and dressing placed
      • Graft or skin substitute placed edges stapled down in strategic spots
        • EVICEL™ applied under graft
        • Complete stapling process
        • Dressings placed
      For Internal Use Only
    • 57. Scar Revision
    • 58. Surgery Videos
    • 59. Breast Reconstruction
    • 60. Q&A
    • 61.
      • Thank You!
    • 62.
      • Back-up slides
    • 63. 2008 Goals Develop new customers and markets (Ortho, Plastics & Burns)
      • HOW?
      • Take share from Baxter
      • Target & convert Tisseel accounts
      • EVICEL is a different product:
        • All human formulation
        • Bovine and aprotinin free
        • Easy to prepare & use
        • Broadest indication with new General Hemostasis indication
      Capture competitive market share Create new markets Protect our existing business Maintain & Protect our existing business - Main Sales Aid - Product Monograph - FDA approval letter - Press Release - Plastics Slim Jim - Burn Slim Jim - Ortho Slim Jim Sales Tools: Sales Tools: - Contracting Strategy - Main Sales Aid Sales Tools:
    • 64. Burn Surgery
      • Steps / Bleeding Challenges
      • Large volume blood loss from burn wound excision and donor sites alike
      • Traumatic wounds similar to burn
      • Burn excised with tangential excision
      • Hemostasis usually with thrombin/epinephrine
      • Grafts harvested – donor sites sprayed with EVICEL™ Fibrin Sealant (Human) and dressing placed
      • Graft meshed
      • Grafts applied to burn wound
        • Edges stapled down in strategic spots
        • EVICEL™ applied under graft
        • Complete stapling process
        • Dressings placed

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