Below The Knee | The Take

MiMedx is buying Sanara MedTech. Conmed is fielding private equity interest. Merit Medical beat earnings, raised guidance, and is sitting on nearly $700 million in available borrowing capacity. Three companies, three transactions, same week. Easy to call that a consolidation wave and move on. But that flattens three different stories into one, and the differences are the actual point.

The backdrop first. Medtech M&A had a decade-high year in 2025 and 2026 hasn't slowed down. PwC's mid-year outlook puts disclosed medtech deal value at $36.5 billion through the first half of the year, on pace with last year's record. Every advisory shop tracking this space right now says the same thing: private equity sitting on record dry powder, financing cheaper than it was twelve months ago, and 2026's defining activity being portfolio reshaping, carve-outs, take-privates, not land-grab growth chasing. That's the environment behind all three deals. It's not the reason for any one of them individually.

But zoom into skin substitutes specifically and the first half of 2026 told a different story than the rest of medtech. Once the CY2026 flat-rate reset took effect in January, CAMP dealmaking didn't just slow, it stalled. Industry analysis from earlier this year described buyers walking away from due diligence entirely because they couldn't price a target whose primary revenue stream was, in one description, under a regulatory guillotine, one major global firm reportedly backed out of a US CAMPs acquisition for exactly that reason. Integra pulled its checkbook back to focus internally. Coloplast pivoted toward operational optimization over acquisition. The category's biggest historical buyers went quiet for six months. Non-CAMP wound technology kept moving in the meantime, New Horizon Medical Solutions picked up an NPWT and micrografting portfolio earlier this year, which is the same distinction from above showing up in the deal data itself: skin substitutes froze, wound care didn't. MiMedx and Sanara isn't just this week's headline. It's arguably the first real move by a CAMP-exposed player since the freeze started, which means the more interesting question isn't why MiMedx did this deal, it's why now, six months in, instead of in February.

Answering that why-now question means being precise about which part of wound care was actually frozen, because it wasn't all of it. The 61 percent revenue decline MiMedx just reported is concentrated in the skin substitute portfolio, the amniotic and placental products used for chronic wounds like DFUs and VLUs under CAMP reimbursement. That's the category the CY2026 flat-rate reset hit, and the category that just spent six months too radioactive to price. Advanced dressings, NPWT, compression, debridement, topical oxygen, none of that runs through the same mechanism, none of it shows up in these numbers or in the freeze described above. Sanara isn't a broader wound care platform either. It shut down its own non-surgical wound program, Tissue Health Plus, in September 2025 after sustained losses, and now runs as a single surgical segment: CellerateRX, BIASURGE, bone fusion products, sold in the OR on surgical incision sites. Different site of care, different patient population, different reimbursement structure entirely. MiMedx isn't trading one wound care exposure for another here. It's paying $350 million to get out of CAMP risk and into a market that risk can't touch. Skin substitutes lost a believer this week. Wound care didn't lose its footing.

Conmed is a cleaner fit for what the advisory reports actually describe: a mid-cap surgical platform with real cash flow, recently trimmed down after exiting its gastroenterology lines, drawing PE interest the same week it posts a solid quarter. Mid-caps trading below fundamentals are exactly what this year's PE capital is hunting for. If a deal closes here, it isn't a distress sale. It's a healthy company getting bought because it's healthy.

Merit Medical is the third piece, and the one worth tracking longest. No live deal, just a company that beat Q2, raised guidance, grew Vascular Intervention double digits, and has the balance sheet to shop again after two acquisitions already this year. Cardiovascular and vascular technology are the two categories every 2026 outlook names as where buyers pay real premiums for growth, not just reshuffle distressed assets. Merit isn't under pressure and isn't a target. It's the buyer, sitting inside the one part of this market everyone agrees is hot.

Line the three up and the honest read isn't "wound care and vascular are consolidating." It's a forced seller in a broken category, a healthy target in a discounted one, and a buyer positioned inside a hot one, all landing in the same week. Same macro tailwind underneath all three, record dry powder, cheaper money than last year, but three different stories riding it. A forced seller shows you where reimbursement risk is concentrated. A take-private target shows you where PE thinks fundamentals are underpriced. A well-capitalized buyer shows you where the smart money still sees growth.

Expect the pattern to repeat, not resolve, and watch Q3 specifically for whether it does. Skin substitute revenue under CAMP is going to keep putting companies in MiMedx's spot for as long as the reimbursement picture stays unsettled, but if the freeze that held for six straight months just broke, MiMedx won't be the only CAMP-exposed name forced to make a move now that the $127 rate is finally something buyers can underwrite against instead of guess at. Mid-cap surgical names trading cheap are going to keep drawing PE as long as the dry powder keeps building. Vascular, cardiovascular, and neurostim names with real growth are going to keep having the balance sheets to buy instead of get bought. Three categories, three kinds of pressure, one week that happened to put a live example of each in front of you at once, and quite possibly the first week of a busier Q3 than the first two quarters of this year gave the CAMP side of this market.

Watch who moves next, see you Friday.

-scott