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Why Standardized 2×11 cm Human Grafts Protect Your OR Budget

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Acellular dermal matrices (ADMs) in a fixed 2×11 cm human graft format can reduce hidden surgical costs by lowering capsular contracture and seroma-related revision rates, shortening operative time, and minimizing intraoperative waste compared with lower‑grade, non‑standardized tissue sheets. For clinics and hospitals, the ROI emerges not from the lowest unit price but from predictable sizing, fewer reoperations, and better alignment with procurement and compliance requirements.

What Standardized 2×11 cm Human Grafts Do & Who They’re For

In implant‑based breast reconstruction, standardized human ADMs act as a soft‑tissue scaffold that reinforces the lower pole, improves pocket control, and provides coverage in prepectoral and dual‑plane techniques. A fixed 2×11 cm graft gives surgeons a known surface area and thickness profile designed to match common implant widths, reducing intraoperative trimming and patch‑work assembly from miscellaneous scraps.

These grafts are most relevant for:

  • Hospital‑based breast oncology programs with high volumes of immediate and delayed implant reconstructions.
  • Aesthetic clinics performing complex revisions (capsular contracture, implant malposition, rippling) where pocket stability is critical.
  • Medspas and boutique practices partnering with hospitals or surgery centers that want predictable supply, standardized billing codes, and traceable lot documentation.

For procurement teams, a single standardized format simplifies SKU management, cost modeling per case, and cross‑comparison with alternative ADMs or meshes.

Topic‑Specific Core Analysis: Hidden Financial Risks of Lower‑Grade, Non‑Standardized Tissue

Lower‑grade, non‑standardized tissue sheets often appear attractive because of a lower sticker price, but economically they carry three clusters of hidden risk:

  1. Increased OR waste and variability
    Non‑standard sizes require manual trimming, combining partial sheets, and improvising coverage, which produces off‑cuts that cannot be reused and are still billed. This raises effective cost per usable square centimeter and increases the chance that a second sheet will be opened “just in case,” adding hundreds of dollars in material charge and idle OR minutes.
  2. Prolonged surgical latency and workflow friction
    Trimming and fitting non‑standard tissue adds steps to pocket preparation and implant placement, particularly in bilateral or radiated cases where planning is complex. Even modest extensions of 10–15 minutes per case become material when OR charges in many U.S. centers fall in the range of 20–80 USD per minute including staffing and overhead.
  3. Higher rates of seroma and capsular contracture driving revisions
    Seroma formation after ADM use has been reported in the mid‑teens percentage range in some series when matrices are not optimized for handling, integration, or pocket design. Capsular contracture in implant‑based breast reconstruction sits around 3–5% at five years in non‑irradiated patients but can reach 20–50% under post‑mastectomy radiation therapy, and poorly performing or inconsistent tissue matrices may fail to mitigate that risk.

Every unplanned return to the OR for seroma evacuation, capsular contracture correction, or implant loss carries not only direct surgical cost but reputational risk, cancelled clinic time, and downstream medicolegal exposure.

By contrast, higher‑grade, standardized ADMs are engineered and validated to support predictable integration and pocket stability, with multiple studies associating ADM use with lower capsular contracture rates and acceptable complication profiles when used appropriately.

Revenue and Operational Impact: Payback Math for Standardized 2×11 cm Grafts

To evaluate ROI, clinics need to look beyond graft unit purchase price and model the “total cost of care” for each reconstructed breast:

  • Device and consumables cost per case (ADM, implants, ancillary supplies).
  • OR time cost: For example, a 90‑minute baseline case vs a 105‑minute case when additional trimming and troubleshooting are required.
  • Probability‑weighted complication and revision costs: Including seroma management, implant loss, capsular contracture surgery, and follow‑up visits.
  • Opportunity cost: OR and surgeon time diverted from revenue‑generating primary aesthetic or reconstruction procedures.
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Economic analyses of ADM use show a recurring theme: ADMs increase direct material costs but can be cost‑effective when they decrease complications, shorten expansion or staging sequences, and improve quality‑adjusted life years. For example:

  • One cost‑utility analysis found that adding ADM increased baseline cost by roughly a few hundred dollars per patient but yielded a gain of about 1.37 quality‑adjusted life years, with an incremental cost‑utility ratio around 264 USD per QALY — within widely accepted cost‑effectiveness thresholds.
  • Controlled cost and outcomes analyses have shown single‑stage implant reconstruction with ADM may reduce postoperative visits and eliminate tissue expander stages, offsetting higher graft costs with fewer procedures and visits.

When you apply this logic to standardized 2×11 cm grafts, the payback drivers become:

  • Fewer partial sheets and off‑label use, reducing waste per case.
  • Shorter OR time via predictable sizing and faster pocket assembly.
  • Lower revision probability if the graft contributes to more stable soft‑tissue support and lower capsular contracture rates in appropriate patients.

For a clinic performing tens to hundreds of breast reconstructions annually, even a small absolute reduction in revision rates or OR minutes per case can convert into tens of thousands of dollars in avoided cost over a few years.

When you reach the point of modeling payback in your own setting, request a quote from ALLWILL for current pricing and availability on standardized 2×11 cm human grafts and certified pre‑owned adjunct devices so you can plug real numbers into your cost models.

Differentiated Advantage: Why a Fixed 2×11 cm Format Commands a Higher Ticket

Standardized 2×11 cm human grafts sit at a higher ticket price than smaller, irregular, or lower‑grade tissue products because they bundle clinical and economic predictability:

  • Predictable coverage: The fixed format matches typical implant footprint dimensions and lower‑pole surface area, limiting the need for multiple overlapping patches and potential dead spaces.
  • Handling and integration characteristics: Premium ADMs often undergo controlled processing and sterilization that maintain biomechanical properties and lower inflammatory responses linked with seroma and contracture.
  • Documentation and traceability: Higher‑grade grafts come with comprehensive lot tracking, processing records, and compatibility documentation that simplify hospital compliance audits.

From a procurement standpoint, the higher unit cost is partially offset by:

  • Lower variance in per‑case material use (most surgeons will need one planned graft of known size rather than opening additional sheets).
  • Standardized pricing and coding, making bundle negotiations with hospital groups and payers more straightforward.
  • Better alignment with clinical protocols that emphasize evidence‑based capsular contracture prevention strategies (e.g., ADM support in irradiated or high‑risk patients).

Alternative approaches — such as prepectoral implants using meshes or autologous flaps like deep inferior epigastric perforator (DIEP) flaps — remain important comparators but carry different OR time, staffing, and donor‑site morbidity profiles that should be weighed separately. The fixed graft format occupies a specific niche where clinics want implant‑based reconstruction efficiency with a more controllable pocket and complication risk.

Practical B2B Decision Aid: Total Cost of Care Table for Standardized vs Non‑Standardized Tissue

The table below presents illustrative ranges and probabilities to help procurement teams compare standardized 2×11 cm grafts to lower‑grade, non‑standardized tissue in implant‑based breast reconstruction. Figures are estimates synthesized from published cost and complication analyses; actual values will vary by country, payer, and case mix.

Estimated Total Cost of Care Per Breast Reconstruction Case (Illustrative Ranges)

Cost / Risk Element Standardized 2×11 cm ADM (Estimate) Lower‑grade / Non‑standardized Tissue (Estimate)
Graft material cost per case (USD) 1,500–2,500 800–1,600
Average OR time for primary procedure (minutes) 90–120 100–135
OR cost per minute (fully loaded, USD) 20–80 20–80
Seroma requiring intervention (probability %) 5–12% with optimized ADM use 10–18% with less controlled matrices
Capsular contracture requiring reoperation (5 yrs) 3–8% non‑irradiated; 10–25% radiated with ADM support 4–12% non‑irradiated; 20–40% radiated without optimized ADM
Direct revision surgery cost per breast (USD) 6,000–12,000 6,000–12,000
Probability of at least one revision within 5 yrs 10–20% overall with standardized ADM protocols 15–30% overall with mixed or low‑grade tissue use
Expected total cost per case over 5 yrs (USD) 12,000–18,000 including revisions 13,000–20,000 including higher revision risk
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The decision signal here is clear: although standardized 2×11 cm ADMs cost more up front, the expected total cost per case over five years narrows or even favors standardized grafts once you factor in OR efficiency and lower revision probabilities. For hospital procurement committees tasked with minimizing lifetime liability rather than per‑unit expenditure, this framing often shifts the preferred choice toward standardized formats.

Use the ranges above as a starting point, then request a quote from ALLWILL for both new and certified pre‑owned compatible devices and grafts so you can run a case‑mix‑specific total cost of care scenario for your program.

Compliance and Asset Protection

Breast reconstruction graft procurement sits at the intersection of surgical quality and regulatory responsibility. Decision‑makers must verify:

  • Regulatory status: Confirm that the ADM is cleared or authorized for soft‑tissue reinforcement and breast reconstruction indications in your jurisdiction (e.g., FDA, CE), and that usage aligns with current labeling.
  • Processing and sterility data: Differentiate between aseptic and sterile ADMs and review microbiological validation reports, as sterility can influence infection and seroma rates.
  • Traceability and documentation: Ensure lot numbers, donor screening, and chain‑of‑custody records are available for each graft and integrated into your hospital’s EMR and implant registry workflows.

For certified pre‑owned adjunct devices (e.g., implants handling equipment, imaging, or preoperative planning tools), asset protection relies on:

  • Verified refurbishment scope and testing protocols.
  • Updated software, service logs, and any remaining manufacturer warranties or third‑party coverage.
  • Clear delineation of what is and isn’t covered under new warranties vs CPO agreements.

ALLWILL’s positioning as a solutions‑focused platform means clinics can source standardized grafts and CPO devices through a single procurement channel that prioritizes documentation, compliance, and expert‑matched configuration rather than just unit price.

Procurement Risks to Avoid + ALLWILL Expert View

Several recurring procurement pitfalls erode ROI and increase liability in breast reconstruction graft sourcing:

  • Selecting grafts on lowest unit price without modeling revision probabilities and OR time implications.
  • Mixing multiple non‑standard tissue products across surgeons and sites, complicating complication tracking and quality improvement.
  • Under‑documenting regulatory status, lot tracking, and sterilization details, leaving gaps during audits or medicolegal reviews.
  • Treating CPO adjunct devices as interchangeable with new units without fully vetting refurbishment, calibration, and documentation.

ALLWILL Expert View: How to Prove ADM ROI in Your Own Numbers

The fastest way to move graft selection from opinion to data is to build a simple five‑year total cost of care model for your own program. Start with your current implant‑based reconstruction volume and stratify by radiation status and revision rate. Then, assign direct OR cost per minute, estimated graft costs, and average cost for a full revision, using ranges from published economic analyses and your own finance data. This will reveal how even a small absolute reduction in capsular contracture or seroma‑related revisions can offset a higher up‑front ADM price. Hospitals that standardize on a fixed 2×11 cm graft format usually see fewer partial sheets opened, more consistent OR durations, and clearer coding, which translates into cleaner reimbursement and lower administrative friction. When clinics source through ALLWILL, they can combine this modeling with vetted new and CPO device options, structured warranty terms, and Smart Center insights so they’re deciding on a full reconstruction ecosystem, not an isolated graft SKU.

Once you have your total cost of care assumptions, request a quote from ALLWILL to validate current ADM and adjunct device pricing, confirm regulatory and documentation coverage, and align supply terms with your hospital’s risk‑management expectations.

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Frequently Asked Questions

What is the typical price range for a standardized 2×11 cm human ADM graft?

Published economic analyses using common ADMs suggest unit costs often fall roughly in the 1,500–2,500 USD range per graft, depending on brand, contract terms, and regional pricing. For precise figures, request a quote from ALLWILL based on your expected annual volume and bundle structure.

How does ROI compare between new and certified pre‑owned devices used alongside these grafts?

New devices carry higher up‑front cost but longer standard warranties and clearer manufacturer support, while certified pre‑owned units reduce capital expenditure at the price of shorter warranties and the need for more diligent documentation review. ROI hinges on utilization, maintenance quality, and service coverage, so clinics should request a quote from ALLWILL that includes both new and CPO options with detailed condition reports.

Do standardized ADMs reduce capsular contracture and revision rates enough to offset their cost?

Evidence shows ADM use can lower capsular contracture rates compared with non‑ADM reconstruction in appropriate patient populations, particularly in complex or irradiated cases. Cost‑utility studies find ADMs can be cost‑effective despite higher material prices when they improve quality‑adjusted life years and reduce multi‑stage procedures. Actual payback depends on your local revision rates and OR cost structure.

What compliance documentation should procurement teams demand with each graft?

Procurement teams should require proof of regulatory clearance or authorization for intended indications, sterility and processing data, donor screening protocols, and full lot‑number traceability integrated into hospital implant registries. When sourcing through platforms like ALLWILL, buyers should also request written confirmation of documentation availability and storage practices.

What lead times and logistics factors matter most when standardizing on a 2×11 cm graft?

Lead times can vary from days to weeks depending on brand, batch availability, and regional distribution networks. Standardizing on a single graft format streamlines forecasting and inventory management, but clinics should coordinate safety stock levels and replenishment cadence with suppliers such as ALLWILL to avoid last‑minute substitutions that undermine protocol consistency.

References

  1. Evidence for the Use of Acellular Dermal Matrix in Implant-Based Breast Reconstructionpmc.ncbi.nlm.nih

  2. Capsular Contracture in Implant-Based Breast Reconstruction—the Effect of Porcine Acellular Dermal Matrixpmc.ncbi.nlm.nih

  3. The use of acellular dermal matrix in breast reconstructionpmc.ncbi.nlm.nih

  4. Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Reviewpmc.ncbi.nlm.nih

  5. Capsular Contracture in Implant-Based Breast Reconstructionpubmed.ncbi.nlm.nih

  6. Capsular contractures following implant-based breast reconstructionacademic.oup

  7. The cost effectiveness of acellular dermal matrix in expander–implant immediate breast reconstructionsciencedirect

  8. Economic analysis of implant-based breast reconstruction with and without the acellular dermal matrixpubmed.ncbi.nlm.nih

  9. Cost analysis of implant-based breast reconstruction with acellular dermal matrixpubmed.ncbi.nlm.nih

  10. Short-term cost-effectiveness of one-stage implant-based breast reconstruction with an acellular dermal matrixpmc.ncbi.nlm.nih

  11. A controlled cost and outcomes analysis of acellular dermal matrix and implant-based reconstructionpubmed.ncbi.nlm.nih

  12. The Effect of Sterile Acellular Dermal Matrix Use on Complication Rates in Implant-Based Immediate Breast Reconstructionspmc.ncbi.nlm.nih

  13. Acellular Dermal Matrix (ADM) Assisted Implant-Based Immediate Breast Reconstruction with Latissimus Dorsi Flappmc.ncbi.nlm.nih

  14. Autologous fat grafting in breast reconstruction and capsular contracture managementoaepublish

  15. Cost analysis of postmastectomy reconstruction with ADM vs DIEP flap

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(e) Notice and Inspection. The limited warranties contained in this Section 8 are made on condition that immediate written notice of any noncompliance with the Equipment’s and/or the Service’s warranty be given to MRP, and provided that MRP’s inspection reveals that Buyer’s claim is valid under the terms of such warranty.

        9.  DISCLAIMERS; NO OTHER WARRANTY. EXCEPT TO THE EXTENT AS PROVIDED IN SECTION 8(c)(i)(D), BUYER ACKNOWLEDGES THAT MRP IS NOT BOUND BY ANY WARRANTY THAT MAY BE SET FORTH IN A MANUFACTURER’S WRITTEN MATERIALS THAT WOULD HAVE APPLIED HAD BUYER PURCHASED THE EQUIPMENT DIRECTLY FROM THE MANUFACTURER IN ITS UNUSED STATE. BUYER ACKNOWLEDGES THAT BUYER HAS NOT RELIED UPON ANY WARRANTY OTHER THAN AS SET FORTH IN THIS AGREEMENT. IN ADDITION, BUYER ALSO HEREBY ACKNOWLEDGES AND AGREES THAT ANY ORAL OR WRITTEN STATEMENTS CONCERNING USE AND REGULATION OF MEDICAL DEVICES SOLD BY MRP ARE AND SHALL BE CONSTRUED AS FOR INFORMATIONAL PURPOSES ONLY AND WITHOUT WARRANTY OR ASSURANCE BY MRP AS TO THEIR ACCURACY OR VALIDITY. MRP ALSO HEREBY DISCLAIMS ANY AND ALL WARRANTIES REGARDING OTHER MEDICAL CARE OR HELP, INCLUDING THE SELECTION OF AESTHETIC AND MEDICAL PROCEDURES AND PRODUCTS FOR, OR CARE OF, PATIENTS. THE LIMITED WARRANTIES OF THIS AGREEMENT, IF APPLICABLE TO ANY EQUIPMENT OR SERVICE FURNISHED UNDER THIS AGREEMENT, CONSTITUTE THE ONLY WARRANTIES MADE WITH RESPECT TO THE EQUIPMENT AND/OR SERVICE AND ANY DEFECT, DEFICIENCY OR NONCONFORMITY. TO THE EXTENT PERMITTED BY LAW, SUCH WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED BY LAW, COURSE OF DEALING, COURSE OF PERFORMANCE, USAGE OF TRADE OR OTHERWISE, INCLUDING, BUT NOT LIMITED TO, ANY EXPRESS OR IMPLIED WARRANTY OF MERCHANTABILITY, TITLE, NONINFRINGEMENT OR FITNESS FOR A PARTICULAR PURPOSE.

        10.  LIMITATION OF LIABILITY. NOTWITHSTANDING ANYTHING TO THE CONTRARY IN THIS AGREEMENT, UNDER NO CIRCUMSTANCES SHALL MRP BE LIABLE FOR ANY INDIRECT, PUNITIVE, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY OR SPECIAL DAMAGES, ARISING FROM, RELATED TO OR CAUSED, DIRECTLY OR INDIRECTLY, WHETHER FORESEEABLE OR NOT, BY THE EQUIPMENT AND/OR THE SERVICES, THE USE OR INABILITY TO USE THE EQUIPMENT, THE RESULTS GENERATED FROM THE EQUIPMENT AND/OR THE SERVICES, THIS AGREEMENT, ANY OTHER ACT OR OMISSION OF MRP, OR BASED UPON ANY OTHER LEGAL THEORY. IN NO EVENT SHALL MRP BE LIABLE FOR ANY LOSSES OF REVENUE, USE, BUSINESS OPPORTUNITY, PROFIT, SAVINGS OR ANY OTHER DAMAGES DUE TO ANY CAUSE WHATSOEVER, EVEN IF MRP OR ITS AGENTS HAS BEEN ADVISED OF THE POSSIBILITY THEREOF. THE FOREGOING IS A SEPARATE, ESSENTIAL TERM OF THIS AGREEMENT, AND SHALL BE EFFECTIVE UPON THE FAILURE OF ANY REMEDY, EXCLUSIVE OR NOT. IN NO EVENT WILL MRP’S TOTAL LIABILITY UNDER THIS AGREEMENT EXCEED THE PURCHASE PRICE ACTUALLY PAID TO MRP BY BUYER FOR THE EQUIPMENT AND/OR THE SERVICES GIVING RISE TO THE CLAIM FOR WHICH DAMAGES ARE BEING SOUGHT. NO SUIT OR ACTION MAY BE BROUGHT BY BUYER, ITS SHAREHOLDERS, DIRECTORS, MANAGERS, EMPLOYEES OR AGENTS FOR ANY BREACH OF THIS AGREEMENT MORE THAN ONE (1) YEAR AFTER THE ACCRUAL OF SUCH CAUSE OF ACTION. IT IS AGREED THAT MRP’S LIABILITY IS SO LIMITED. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, BUYER ASSUMES ALL RISK AND LIABILITY FOR THE RESULTS OBTAINED BY THE USE OF ANY EQUIPMENT IN THE PRACTICE OF ANY PROCESS, WHETHER IN TERMS OF OPERATING COSTS, GENERAL EFFECTIVENESS, SUCCESS OR FAILURE, AND REGARDLESS OF ANY ORAL OR WRITTEN STATEMENTS MADE BY MRP, BY WAY OF TECHNICAL ADVICE OR OTHERWISE, RELATED TO THE USE OF THE EQUIPMENT.

        11.  BUYER’S REPRESENTATIONS AND WARRANTIES. Buyer represents and warrants to MRP that: (a) Buyer is duly organized, validly existing, and in good standing in the jurisdiction of Buyer’s formation; (b) Buyer is duly qualified to do business and is in good standing in every jurisdiction in which such qualification is required; (c) Buyer has the full right, power, and authority to enter into this Agreement and to perform Buyer’s obligations under this Agreement; (d) the execution of this Agreement by the person whose signature is set forth at the end hereof has been duly authorized by all necessary corporate action of Buyer; (e) when executed and delivered by each of MRP and Buyer, this Agreement will constitute the legal, valid and binding obligation of Buyer, enforceable against Buyer in accordance with its terms; (f) Buyer is in compliance with all applicable laws relating to this Agreement, the Equipment and the operation of Buyer’s business; (g) Buyer is not insolvent and is paying all of its debts as they become due; and (h) all financial information that Buyer has provided to MRP is true and accurate and fairly represents Buyer’s financial condition.

        12. PROPRIETARY RIGHTS.

(a) Ownership. No sale shall be construed as granting to Buyer any license or other right in, or to, any of MRP’s (i) patents; (ii) trademarks; (iii) internet domain names, whether or not trademarks, registered by any authorized private registrar or governmental authority, web addresses, web pages, websites and URLs; (iv) works of authorship, expressions, designs and design registrations, whether or not copyrightable, including copyrights and copyrightable works, software and firmware, technical data, data files, and databases and other specifications and documentation; (v) trade secrets; (vi) environmental or other testing applicable to the Equipment and/or the Services; and (vii) industrial and other intellectual property rights, and all rights, interests, and protections that are associated with, equivalent or similar to, or required for the exercise of, any of the foregoing, however arising, in each case whether registered or unregistered and including all registrations and applications for, and renewals or extensions of, such rights or forms of protection pursuant to the laws of any jurisdiction throughout in any part of the world (collectively, the “Intellectual Property Rights”).

(b) Prohibited Acts. Buyer shall not (i) take any action that might interfere with any of MRP’s rights in or to Intellectual Property Rights, including MRP’s ownership or exercise thereof; (ii) challenge any right, title, or interest of MRP in or to the Intellectual Property Rights; (iii) make any claim or take any action adverse to MRP’s ownership of the Intellectual Property Rights; (iv) register or apply for registrations, anywhere in the world, for MRP’s trademarks or any other trademark that is similar to MRP’s trademarks or that incorporates MRP’s trademarks in whole or in confusingly similar part; (v) use any mark, anywhere that is confusingly

similar to MRP’s trademarks in whole or in confusingly similar part; (vi) engage in any action that tends to disparage, dilute the value of or reflect negatively on the Equipment and/or the Services or any of MRP’s trademarks; (vii) misappropriate any of MRP’s trademarks for use as a domain name without prior written consent from MRP; or (viii) alter, obscure or remove any of MRP’s trademarks, or trademark or copyright notices or any other proprietary rights notices placed on the

Equipment, marketing materials or other materials that MRP may provide.

        13.  CONFIDENTIAL INFORMATION. Without the prior written consent of MRP,Buyer, directly or indirectly, shall not disclose (and will direct its directors, shareholders, employees and agents not to disclose) any Confidential Information. The term “Confidential Information” means any information of or relating to MRP or the Equipment and/or the Services not generally known to the public (other than as a result of disclosure in violation of this Agreement) in spoken, printed, electronic or any other form or medium, including, but not limited to, business processes, practices, methods, policies, plans, publications, documents, research, operations, services, strategies, techniques, agreements, contracts, transactions, potential transactions, know-how, trade secrets, databases, manuals, records, supplier information, financial information, accounting information, legal information, marketing information, pricing information, payroll information, personnel information, and supplier lists.

        14.  NON-SOLICITATION. Buyer agrees not to solicit or hire any personnel of MRP involved with the delivery of the Services during the provision of such Services and for twelve (12) months after the completion of such Services; provided, however, that Buyer may hire individuals employed by MRP who, without other solicitation, respond to advertisements or solicitations aimed at the general public.

        15.  EQUITABLE REMEDIES. Buyer acknowledges and agrees that (a) a breach or threatened breach by Buyer of any of its obligations under Sections 13 or 14 would give rise to irreparable harm to MRP for which monetary damages would not be an adequate remedy and (b) in the event of a breach or a threatened breach by Buyer of any such obligations, MRP shall, in addition to any and all other rights and remedies that may be available to MRP at law, at equity, or otherwise in respect of such breach, be entitled to equitable relief, including a temporary restraining order, an injunction, specific performance, and any other relief that may be available from a court of competent jurisdiction, without any requirement to post a bond or other security, and without any requirement to prove actual damages or that monetary damages will not afford an adequate remedy. Buyer agrees that Buyer will not oppose or otherwise challenge the appropriateness of equitable relief or the entry by a court of competent jurisdiction of an order granting equitable relief, in either case, consistent with the terms of this Section 15.

        16.  INDEMNIFICATION. Buyer agrees to indemnify, defend and hold harmless MRP and its directors, shareholders, employees and agents (collectively, “MRP Indemnitees”) against any liability, damage, loss or expense incurred by or imposed in connection with any claims, suits, actions, demands or judgments arising out of (a) any breach or non-fulfillment of any representation, warranty or covenant set forth in this Agreement by Buyer or its directors, managers, employees or agents (collectively, “Buyer’s Agents”); (b) any negligent act or omission or willful misconduct of Buyer or Buyer’s Agents in connection with this Agreement; (c) any bodily injury, death of any person or damage to real or tangible personal property caused by Buyer or Buyer’s Agents, including the use of unauthorized parts in or service of the Equipment; (d) any failure by Buyer or Buyer’s Agents to comply with any applicable laws; (e) any fraud or other intentional acts by Buyer or Buyer’s Agents; and (f) the use or operation of the Equipment, including, without limitation, any medical and/or surgical procedures performed by Buyer, and any of Buyer’s Agents, using the Equipment unless said damages are determined by a court of competence jurisdiction to be solely by the gross negligence of MRP or solely as result of a breach by MRP of the limited warranties contained herein.

        17.  DEFAULTS; REMEDIES. Notwithstanding anything herein to the contrary, should Buyer fail to pay for the order or any other amount, in whole or in part, when due or perform its other obligations under this Agreement or as otherwise mutually agreed in writing between Buyer and MRP (each, a “Default”), then MRP may take any and all actions available under law or equity to collect said amounts with a ten (10) day prior written notice, including, but not limited to, enforcing its security interest, accelerating the payment of and declaring immediately due and payable any unpaid balance of the order, referral to outside collection agencies and/or commencement of legal action. MRP’s rights shall be cumulative, and it shall not be required to have attempted to realize upon to the Equipment before taking any other collection actions. MRP may require that Buyer assemble and return any or all of the Equipment to MRP and, in the event Buyer fails to return such Equipment peaceably, enter upon the premises where such Equipment is located, with or without legal process, and repossess such Equipment. Upon a Default, Buyer agrees to pay upon MRP’s demand: (i) all costs and expenses incurred by MRP or its assignee in connection with the enforcement of any remedies, including all expenses incurred in connection with the return, sale, release or other disposition of the Equipment, including attorneys’ fees and other costs incurred by MRP or its assignee in enforcing or defending its rights and remedies under this Agreement and any other written agreement between Buyer and MRP.

        18.  COMPLIANCE WITH LAWS. Buyer shall (a) carry out the transactions contemplated by this sale and deal with the Equipment in conformity with all applicable laws, rules and regulations of all government authorities, including, without limitation, export laws, (b) obtain all permits and licenses required in connection with the purchase, shipment, installation or use of the Equipment, and (c) be solely responsible to fully understand and comply with laws, rules and regulations. Any information provided is as a convenience only.

        19.  FURTHER ASSURANCES. Upon MRP’s reasonable request, Buyer shall, at its sole cost and expense, execute and deliver all such further documents and instruments, and take all such further acts, necessary to give full effect to this Agreement.

        20.  ASSIGNMENT; SUCCESSORS AND ASSIGNS. Buyer cannot delegate any duties nor assign any rights or claims under this Agreement without MRP’s prior written consent, and any such attempt or assignment shall be void. In the event that Buyer finances its acquisition of any Equipment with a third party, Buyer may direct MRP to transfer title of such Equipment to such third-party financing company, with all remaining terms and conditions of this Agreement remaining in full force and effect. This Agreement is binding on and inures to the benefit of the parties to this Agreement and their respective permitted successors and permitted assigns.

        21.  NO THIRD-PARTY BENEFICIARIES. Subject to Section 16, this Agreement benefits solely the parties to this Agreement and their respective permitted successors and assigns, and nothing in this Agreement, express or implied, confers on any other person any legal or equitable right, benefit, or remedy of any nature whatsoever under or by reason of this Agreement.

        22.  GOVERNING LAW; VENUE. The application of the UN Convention on Contracts for the International Sale of Goods is expressly excluded. The parties agree that any and all claims, demands, disagreements, controversies or disputes arising out of or relating to this Agreement and any agreement or document delivered in connection herewith (collectively, “Claims”) shall be governed by and construed in accordance with the laws of the State of Utah and adjudicated exclusively in the state and federal courts located in or nearest to Summit County, Utah, which courts shall have the sole and exclusive jurisdiction and venue for adjudication of all Claims. The parties hereby agree upon, consent and stipulate to the jurisdiction and venue of the aforementioned courts for the adjudication of all Claims, to the exclusion of all other courts, forums and venues whatsoever.

        23.  NON-DISPARAGEMENT. Buyer shall not disparage MRP or MRP’s trademarks, websites, products or services, or display any such items in a derogatory or negative manner on any website or in any public forum or press release.

        24.  NOTICES. Any notice, demand, or communication required, permitted or desired to be given hereunder shall be deemed effectively given when personally delivered, when sent by electronic means, when received by overnight courier, or when mailed by prepaid, certified or registered mail, return receipt requested, addressed to the other party at its address set forth on the Quote or to such other address that the receiving party may designate from time to time in accordance with this Section 25.

        25.  PUBLIC ANNOUNCEMENTS. Unless otherwise stated herein, neither party shall issue a press release or otherwise advertise, make a public statement or disclose to any third-party information pertaining to the relationship arising under this Agreement, the existence or terms of this Agreement, the underlying transactions between MRP and Buyer or agent for Buyer or refer to the other party in relation to this Agreement without the other party’s prior written approval.

        26.  ENTIRE AGREEMENT; ADDITIONAL OR INCONSISTENT TERMS. Subject to Section 32, this Agreement constitutes the sole and entire agreement between the parties hereto relating to the subject matter hereof, and any unincorporated representation, affirmation of fact, course of prior dealings, promise or condition in connection therewith, or usage of the trade, shall not be binding on either party. Terms and conditions set forth which differ from, conflict with or are not included in this Agreement shall not be part of any agreement between MRP and Buyer unless both parties specifically accept such terms and conditions in writing.

        27.  WAIVER. No waiver under this Agreement is effective unless it is in writing and signed by the party waiving its right. Any waiver authorized on one occasion is effective only in that instance and only for the purpose stated and does not operate as a waiver on any future occasion. None of the following constitutes a waiver or estoppel of any right, remedy, power, privilege or condition arising from this Agreement: any failure or delay in exercising any right, remedy, power or privilege or in enforcing any condition under this Agreement; or any act, omission or course of dealing between the parties.

        28.  SURVIVAL. Subject to the limitations and other provisions of this Agreement, the representations and warranties of Buyer contained herein shall survive the expiration or earlier termination of this Agreement for a period of twelve (12) months after such expiration o termination and (b) this Section 29 and Sections 10, 12, 13, 14, 15, 16, 17, 21, 22, 23, 24, 26, and 32 of this Agreement, as well as any other provision that, in order to give proper effect to its intent, should survive such expiration or termination, shall survive the expiration or earlier termination of this Agreement. All other provisions of this Agreement shall not survive the expiration or earlier termination of this Agreement.

        29.  RELATIONSHIP OF PARTIES. Nothing in this Agreement creates any agency, joint venture, partnership or other form of joint enterprise, employment or fiduciary relationship between the parties. Neither party has any express or implied right or authority to assume or create any obligations on behalf of or in the name of the other party or to bind the other party to any contract, agreement or undertaking with any third party.

        30.  HEADINGS. The headings in this Agreement are for reference only and do not affect the interpretation of this Agreement.

        31.  ORDER OF PRECEDENCE. In the event of conflict between the Quote, a written agreement by MRP, and these Terms, the order of priority shall be: (1) the written

agreement by MRP, if only if executed by an MRP Officer, (2) the Quote and (3) these Terms, and only to the extent of the direct conflict. Notwithstanding the foregoing, MRP shall not be bound by, and specifically objects to, any terms, conditions or other provisions, both written and oral, which are different from, in addition to or inconsistent with the provisions of this Agreement which are set forth in any purchase order, receipt, acceptance, confirmation, correspondence or otherwise of, or by, Buyer. Fulfillment of Buyer’s order shall not constitute acceptance of any of Buyer’s terms and conditions and does not serve to modify or amend the terms and conditions contained herein.

        32.  SEVERABILITY. If any part of this Agreement is held to be void, illegal or unenforceable, then it shall be deemed to be severed from this Agreement and the remaining provisions shall continue in full force and effect; provided, however, that if any fundamental term or provision of this Agreement is held to be void, illegal or unenforceable, the remainder of this Agreement shall be unenforceable. Upon a determination that any term or provision is void, illegal or unenforceable, the parties shall negotiate in good faith to modify this Agreement to effect the original intent of the parties as closely as possible in order that the transactions contemplated hereby be consummated as originally contemplated to the greatest extent possible.