OPENING SHOT
The Market Doesn't Wait. Neither Should You.
Friday's edition didn't go out. I was in Austin at the Tissue Repair Summit Spring and the Advanced Wound Care Summit — two days of roundtables, panels, and unfiltered signal from the commercial and clinical leaders actually navigating this market in real time.
The week didn't slow down while I was in the room. Five earnings reports either dropped or were released in the trailing days. A Nasdaq filing hit the wire. A 169% revenue print from a company most of this market forgot about. And a global distribution push from a company trying to leverage a changed regulatory landscape into an international footprint.
This is the market right now — moving fast, rewarding companies that built right, and creating an entirely new set of winners in categories that didn't exist three years ago.
Here's the week.
FROM AUSTIN | What the Room Said
I spent May 14–15 at the TRSS/AWCS meeting in Austin — hosting a roundtable on AI, presenting on innovation hitting the market, and sitting in on two days of sessions that covered everything from diagnostics and limb salvage to reimbursement mechanics, Bayesian statistics, and what the next decade in wound care actually looks like. A few threads worth pulling.
The innovation index panel was one of the most concentrated showcases of where the technology frontier is heading. Six companies on stage, each representing a distinct vector of change: Venture OneView, WoundScribe.AI, Wound Force One / RENA AI, Silhouette® by ARANZ Medical, Swift Medical, and Yarrow Care. Imaging intelligence, AI-driven documentation, ambient clinical capture, outcome modeling — the infrastructure for a data-native wound care delivery model is being built right now, across multiple platforms simultaneously. The competitive dynamic in this space is no longer who has the best hardware. It's who owns the workflow.
Bayesian statistics were having a moment. Zwelithini (Zweli) Tunyiswa led what turned out to be one of the more substantive methodological conversations of the conference — how Bayesian statistical frameworks can fundamentally accelerate clinical trials in wound care by generating meaningful evidence from smaller datasets, faster. The FDA has already recognized this approach in other sectors. The argument in Austin was that wound care is overdue to adopt it. The implication for the market is significant: if the evidence burden for new CAMPs, biologics, and devices can be satisfied more efficiently, the pipeline economics change. Watch for Bayesian RWE framing to become a standard part of clinical validation narratives in this space over the next 18 months.
What do strategics actually look for in a partner? The partnership panel brought together voices from across the spectrum — large strategics, growth-stage companies, and everything in between. The consistent through-line: prove you're solving a problem that's already verified. Not a problem you've invented a solution for and are now searching for clinical justification. Speed to market matters, but only if the internal sales process and readiness infrastructure are already in place to absorb scale. Portfolio gap-fill logic drives acquisition interest more than any other single factor. And companies that have already figured out their sales channel, whether key opinion leaders, direct, or distributor come to the table with a fundamentally stronger negotiating position.
I chaired a roundtable on AI, responsible use, and where it's headed. The conversation covered where AI is already embedded in clinical workflows versus where it's still aspirational, what responsible deployment looks like in a regulatory environment that hasn't fully caught up, and the harder question of who owns the liability when AI-assisted documentation or imaging is part of a care decision. The room had a range of views, from operators actively deploying AI tools today to clinicians still deeply skeptical. What everyone agreed on: the question is no longer whether AI enters wound care. It's whether the field gets ahead of the governance questions before they're decided for us.
The "What's Next in Wound Care" panel — Mitch Sanders, Bruce Davies, and Chris Broderick — was genuinely one of the best conversations of the two days. Digital infrastructure, data interoperability, pharma's expanding interest in the wound space, and the clinical and commercial frontier around neuropathic wound management. The framing I'll take from it: wound care is so much more than CAMPs. The CAMP disruption has dominated the narrative for five months, but the category is broader, the science is advancing on multiple fronts simultaneously, and the market that emerges on the other side of this reimbursement transition is going to look meaningfully different from the one that entered it. That's not a recovery story. That's a rebuild story. And the energy in that room reflected it.
BTK INNOVATION INDEX — 283 COMPANIES. ONE INDEPENDENT SCORE.
Every company in this edition is indexed. Six dimensions. No advertiser influence. No purchased scores.
→ Access the 2026 BTK Innovation Index at intelligence.belowtheknee.co/report
WOUND CARE
Commercial | Conexeu Sciences Files for Nasdaq — A Collagen Platform Worth Watching
Conexeu Sciences is an early-stage medical device company developing CXU, a temperature-responsive, collagen-based extracellular matrix scaffold designed to transition from a liquid to a gel-like structure in the body. The scaffold is intended to conform to irregular wound geometries and support cellular infiltration and vascular ingrowth during tissue repair. The initial focus is advanced wound care, with additional research exploring dental soft-tissue, regenerative aesthetics, veterinary applications, and research-use bioinks for 3D bioprinting. The technology is protected by patents in the U.S., EU, Japan, and Australia, and the company expects its common stock to begin trading around May 21, 2026.
The BTK read: Conexeu is pre-revenue and pre-clearance — the CXU scaffold remains investigational, with a pre-510(k) submission targeted for Q3 2026. This is not a commercial story yet. But the technology architecture is worth attention: a thermosensitive collagen-based ECM that conforms to irregular wound beds addresses a real clinical problem in a way existing flowable matrices don't fully solve. Multi-jurisdiction IP, a decade of university research, and a management team with depth. Companies going public at this stage face a steep commercialization road - the platform warrants a spot on the watchlist.
FINANCE | Q1 2026 Earnings Roundup
Four companies reporting into a market still processing the most disruptive reimbursement transition in the sector's recent history. The pattern is consistent: product and channel positioning relative to the January 1 reset determined Q1 outcomes more than anything else in management's control.
Nuo Therapeutics (OTCQB: AURX) — 169% Growth, PRP's Structural Moment
Nuo Therapeutics reported Q1 2026 total revenues of approximately $1.3 million, up 169% over Q1 2025 and 20% above Q4 2025, with Aurix branded product revenues increasing more than 30% sequentially and net operating loss narrowing to $446,000 from $745,000 a year earlier. The company attributed the surge directly to the vastly changed reimbursement landscape, with interest in autologous platelet-rich plasma immediate and vigorous following the January 1 skin substitute reset. The 2026 CMS national average reimbursement rate for the Aurix System is $2,108 per treatment in hospital outpatient settings and $1,064 in physician offices — rates that, combined with the sudden contraction of competing skin substitute options, have created a commercial opening the platform hadn't previously seen. The company also entered a $1.0 million Loan and Security Agreement to fund working capital toward breakeven operations.
The BTK read: Nuo is the clearest single data point illustrating what the January 1 reset created on the other side of the disruption. Autologous PRP was always clinically logical — no allogenic tissue, no complex billing path. What it lacked was a moment. The Smith+Nephew private label relationship gives Aurix commercial infrastructure it didn't build organically. The revenue base is small and the company remains pre-profitability — but 169% growth in a contracting market is a signal worth tracking.
Avita Medical (NASDAQ: RCEL) — $19.3M Revenue, MAC Harmonization Complete, Cohealyx Building
Avita Medical reported Q1 2026 revenue of approximately $19.3 million, up 4% year over year and roughly 10% sequentially, the company's highest quarterly revenue over the past year with gross margin of 81.7% overall, RECELL-only margin held at 85.0%, operating expenses down 11% to $24.5 million, and net loss narrowed to $10.6 million or $0.35 per share. Full-year 2026 guidance was reaffirmed at $80–$85 million. All seven Medicare Administrative Contractors now publish clinician payment rates for RECELL, removing the reimbursement uncertainty that suppressed utilization through 2025. Cohealyx interim data showed a median time to grafting of approximately 11 days and a 20-day reduction to graft readiness relative to benchmark, with high investigator satisfaction. The quarter also included announcement of a 10-year BARDA agreement valued at up to $25.5 million and new RECELL GO clearance in Australia and New Zealand.
The BTK read: MAC harmonization on RECELL rates is a clean signal - the uncertainty is resolving. Cohealyx interim data showing a 20-day improvement in graft readiness is clinically material if it holds in broader use. 81.7% gross margin across an expanding portfolio is strong structural evidence. BARDA adds a durable non-commercial revenue layer. Avita is executing well in a market where many peers are contracting.
Sanuwave (NASDAQ: SNWV) — Record Q1 Revenue, Frozen Market Breaking Up
Sanuwave reported Q1 2026 revenues of $9.6 million, up 3.1% year over year — the highest Q1 quarterly revenues in company history with Ultramist consumables revenue up 15% to $6.7 million and the active installed base expanding to 1,382 systems. Gross margin was 77.3%, with pressure driven by wholesale pricing through resellers. CEO Morgan Frank described Q1 as starting with a "shock pause" as many providers seemed surprised the skin substitute changes had actually taken effect, creating a frozen market in January with recovery appearing to begin in February and continuing through the quarter. Q2 guidance is 10–15% year-over-year growth, with full-year guidance maintained at $51–$55 million.
The BTK read: The "shock pause" framing is the most honest characterization of January 2026 from any management team this cycle. The market froze, then started moving. Sanuwave's UltraMIST positioning outside the CAMP disruption zone; directed energy MIST therapy, not a skin substitute created the structural resilience here. Record applicator unit volumes and a growing installed base are the right metrics to watch.
Treace Medical (NASDAQ: TMCI) — Revenue Down 10%, Portfolio Transition Underway
Treace Medical reported Q1 2026 revenue of $47.2 million, down 10% year over year, with a net loss of $18.0 million or $0.28 per share, adjusted EBITDA loss of $5.5 million, and gross margin essentially unchanged at 79.3%. Full-year 2026 revenue guidance was reaffirmed at $202–$212 million with adjusted EBITDA loss of $4–$6M. Revenue declines were driven primarily by a shift toward lower-priced, minimally invasive products, with management guiding for continued pressure until the seasonally strongest fourth quarter, supported by accelerating case volumes, the anniversary of the mix shift, and planned 2026 product launches. Approximately 35% of the Lapiplasty surgeon base had incorporated at least one of the three new bunion systems since launch, up from 25% in Q4 2025, and cash and marketable securities held at $51.9 million.
The BTK read: The 10% revenue decline tells one story; the held guidance and EPS beat tell another. Treace is executing a portfolio transition in real time, the Lapiplasty thesis expanding into a broader bunion correction platform, with average selling prices absorbing the cost while procedure volumes build. The balance sheet provides runway to test the fourth-quarter thesis.
📅 UPCOMING EVENTS
May 31–June 2 | WOCNext 2026 — WOCN Society annual clinical gathering.
June 21 | St. Louis, MO — St. Louis Wound & Vascular Symposium, Hilton Frontenac.
August 6–9 | Nashville, TN 🔥 APMA Annual Scientific Meeting (The National) — Gaylord Opryland.
September 10–11 | New Orleans, LA 🔥 IPAWS & Tissue Repair Summit (Kernexus) — The Ritz-Carlton.
September 14–16 | Louisville, KY 🔥 NAWCO HEAL Conference 2026
September 23–27 | Kuala Lumpur, Malaysia 🔥 WUWHS 2026
October 15–18 | Las Vegas, NV 🔥 SAWC Fall 2026 — Caesars Palace.
October 22–24 | Anaheim, CA 🔥 DFCon 2026 — JW Marriott.
December 9–12 | Phoenix, AZ — Desert Foot Multi-Disciplinary Limb Salvage & Wound Care Conference.
Below The Knee | Independent market intelligence for wound care, limb salvage, vascular intervention, and foot & ankle. Not subscribed? → belowtheknee.co/newsletter Forward this to one person in your network who works in this space.
See you next week. — Scott