Teleconferência de Resultados do 3º Trimestre de 2026 da MiMedx (MDXG): Crescimento Cirúrgico e Guidance Atualizado

Principais Destaques

• A MiMedx reportou vendas líquidas no 3T26 de US$ 62 milhões, uma queda de 45% na comparação anual, com as mudanças nos reembolsos do Medicare continuando a pressionar a área de Cuidados com Feridas.
• As vendas líquidas do segmento Cirúrgico subiram 9% na comparação anual, para US$ 40 milhões, com o crescimento em volume ficando na faixa de 15%. A administração afirmou que o crescimento subjacente teria ficado na faixa de 15% excluindo as vendas de tecidos business-to-business do ano anterior e os ajustes mais altos de rebates.
• As vendas líquidas de Cuidados com Feridas caíram 71%, para US$ 22 milhões, embora o volume nos Centros de Cuidados com Feridas tenha aumentado mais de 20% na comparação anual e 7% em relação ao trimestre anterior.
• A margem bruta atingiu 80%, uma melhora de aproximadamente 11 pontos percentuais em relação ao trimestre anterior devido a reduções de custos, maior capacidade de produção fabril e eficiências operacionais.
• O EBITDA ajustado voltou ao terreno positivo, em US$ 2 milhões, uma melhora sequencial de cerca de US$ 10 milhões. O prejuízo líquido GAAP foi de US$ 9 milhões, ou US$ 0,06 por ação.
• A MiMedx atualizou sua projeção de vendas líquidas autônomas para 2026 para entre US$ 250 milhões e US$ 260 milhões. A aquisição pendente da Sanara MedTech continua sujeita a uma segunda solicitação (second request) da FTC, e a administração não forneceu um cronograma para o fechamento.

Principais Dados Financeiros

Desempenho Operacional e dos Negócios

Crescimento do segmento Cirúrgico permaneceu abrangente

O segmento Cirúrgico representou aproximadamente dois terços das vendas líquidas totais. O crescimento foi impulsionado por AMNIOFIX, AMNIOEFFECT, produtos particulados e pelo recém-lançado G4Derm Plus.

O crescimento reportado do segmento Cirúrgico foi reduzido por dois fatores. O 3T25 incluiu quase US$ 1 milhão em vendas oportunistas de tecido de placenta no modelo business-to-business que não se repetiram. Os ajustes de rebates também aumentaram devido a atividades promocionais de curto prazo e a certos programas de clientes que atingiram suas metas. A administração espera menos oscilações decorrentes desses itens no 4T.

Um tribunal distrital dos EUA anulou a determinação da FDA de que o AXIOFILL não deveria ser classificado como um produto da Seção 361 e devolveu a matéria à agência para reavaliação. A MiMedx também informou que fez progressos substanciais em duas submissões 510(k) no segmento Cirúrgico e espera pelo menos uma liberação antes do fim do ano.

Cuidados com Feridas seguiu absorvendo mudanças nos reembolsos

O segmento de Cuidados com Feridas permaneceu sob pressão devido à estrutura de reembolso do Medicare implementada em 1º de janeiro de 2026. A administração citou menores reembolsos, pressão de preços, redução nos volumes do setor e contínua instabilidade fora dos Centros de Cuidados com Feridas.

A migração de pacientes para os Centros de Cuidados com Feridas foi um destaque positivo relativo. A MiMedx registrou um crescimento de volume de mais de 20% na comparação anual e 7% em relação ao trimestre anterior nesse canal. A empresa também relatou tração inicial na sua oferta de PRP e continua a financiar ensaios clínicos randomizados e controlados para dois produtos recentes.

Ações de custos melhoraram a rentabilidade e a liquidez

Custos de produção menores, maior capacidade fabril e eficiências operacionais impulsionaram a margem bruta em relação ao trimestre anterior. As despesas de vendas e marketing caíram para US$ 40 milhões, ante US$ 54 milhões, embora tenham subido como percentual das vendas para 64% devido à menor receita.

A MiMedx quitou o saldo devedor principal restante de US$ 17 milhões do seu empréstimo a termo com o Citizens e encerrou o 3T sem empréstimos a termo ou crédito rotativo pendentes.

A empresa também celebrou um acordo judicial e de licenciamento de US$ 25 milhões com uma parte que, segundo ela, havia infringido suas patentes. Outros dois processos de patentes permanecem em litígio.

Projeções da Administração

As projeções da MiMedx excluem qualquer impacto da aquisição pendente da Sanara.

• Vendas líquidas do ano de 2026: US$ 250 milhões a US$ 260 milhões.
• Receita do segmento Cirúrgico no 4T: Crescimento de dígito único alto na comparação anual.
• Receita de Cuidados com Feridas no 4T: Crescimento de dígito único médio em relação ao trimestre anterior.
• Margem bruta do 4T: Espera-se que fique próxima do nível de 80% registrado no 3T.
• Despesas de vendas e marketing do 4T: 58% a 60% das vendas líquidas.
• Despesas gerais e administrativas (G&A) GAAP do 4T: Aproximadamente US$ 18 milhões a US$ 19 milhões.
• Despesas de P&D do 4T: Aproximadamente US$ 3 milhões a US$ 3,5 milhões.
• EBITDA ajustado do 4T: A administração espera um modesto crescimento em relação ao trimestre anterior.

Se a transação com a Sanara for concluída, a administração espera que a empresa combinada gere uma taxa de execução de receita (run-rate) próxima de US$ 400 milhões, alcance crescimento de dois dígitos e realize pelo menos US$ 20 milhões em sinergias de custos anualizadas. Também projeta uma margem EBITDA ajustada de pelo menos 20% no primeiro ano completo e uma alavancagem líquida abaixo de 3x até o final desse período.

Riscos e Pontos de Atenção

• O mercado de Cuidados com Feridas ainda não estabeleceu uma base estável de preços ou volumes, o que limita a visibilidade da administração sobre o momento e o ritmo de recuperação.
• A administração espera que a estrutura do Medicare para substitutos de pele em 2027 permaneça amplamente semelhante à de 2026, embora as tabelas de tarifas finais ainda não tivessem sido publicadas no momento da teleconferência.
• A segunda solicitação (second request) da FTC prorrogou o período de espera Hart-Scott-Rodino para a aquisição da Sanara. A administração continua comprometida com o negócio, mas não pode controlar ou especificar o cronograma de fechamento.
• A MiMedx começou a incorrer em uma modesta taxa de compromisso (ticking fee) relacionada ao compromisso de financiamento de US$ 300 milhões da Hayfin Capital, pagável quando a aquisição for concluída e a linha de crédito for liberada.
• O desempenho da margem bruta no longo prazo dependerá em parte do mix de produtos, apesar das recentes eficiências fabris.

Destaques das Perguntas e Respostas dos Analistas

• Rebates do segmento Cirúrgico: A administração descreveu o nível elevado de rebates no 3T como ligado a promoções temporárias e ajustes de compensação para programas de clientes. Ela não espera o mesmo nível de oscilações relacionadas a rebates no 4T.
• Cronograma da Sanara: A MiMedx afirmou que seu diálogo com a FTC tem sido positivo, mas optou por não fornecer uma nova data de fechamento. O planejamento de integração continuou durante o atraso.
• Estabilização de Cuidados com Feridas: A administração afirmou que o mercado continua difícil de prever após apenas três trimestres sob a nova estrutura de reembolso. Ela acredita que a MiMedx está relativamente bem posicionada nos Centros de Cuidados com Feridas assim que os preços e volumes se estabilizarem.
• Meta de margem da empresa combinada: A administração afirmou que a meta de margem EBITDA ajustada de 20% não exige uma recuperação significativa de curto prazo no segmento de Cuidados com Feridas e continua a ver a meta como alcançável após o fechamento da aquisição.
• Evidências clínicas: A MiMedx reafirmou seu compromisso com a pesquisa clínica, incluindo dois ensaios clínicos randomizados e controlados em andamento envolvendo produtos lançados recentemente.

Transcrição Completa da Teleconferência de Resultados

Transcrição completa da teleconferência de resultados

Comentários da administração

Operator

Greetings, and welcome to the MiMedx Third Quarter 2026 Operating and Financial Results Conference Call. [Operator Instructions] As a reminder, this conference is being recorded.

I will now turn the conference over to Matt Notarianni, Head of Investor Relations. Thank you, Matt. You may begin.

Matthew Notarianni

Thank you, operator, and good afternoon, everyone. We are pleased to welcome you to MiMedx's third quarter 2026 operating and financial results conference call.

With me on today's call are Chief Executive Officer, Joe Capper; and Chief Financial Officer, Doug Rice.

As part of today's webcast, we are simultaneously displaying slides that you can follow. You can access the slides from the Investor Relations website at mimedx.com. Joe will kick us off today with a summary of our third quarter 2026 operating and financial highlights, and Doug will provide a detailed review of our results for the quarter. And then we will conclude with some additional updates before we open the line for your questions.

Before we begin, I would like to remind you that our comments today will include forward-looking statements, including statements regarding future sales, operating results and cash balance growth, future margins and expenses, our product portfolios, expected market sizes for our products and expectations regarding the Sanara acquisition, including expected benefits and financial performance of the combined company. These expectations are subject to risks and uncertainties, and actual results may differ materially from those anticipated due to many factors, including competition, access to customers, the reimbursement environment and unforeseen circumstances and delays.

Additional factors that could impact outcomes and our results include those described in the Risk Factors section of our annual report on Form 10-K and our quarterly report on Form 10-Q. Also, our comments today include non-GAAP financial measures, and we provide a reconciliation to the most comparable GAAP measures in our press release, which is available on our website at mimedx.com. Furthermore, all our statements are as of today, October 28, 2026, and we have no obligation to update any forward-looking statement we make.

With that, I'm now pleased to turn the call over to Joe Capper. Joe?

Joseph Capper

Thanks, Matt, and good afternoon, everyone. Thank you for joining us on today's call. The results and trends of the third quarter reinforce the strategic rationale for the direction we are taking the company. Our Surgical business performed well despite somewhat softer procedure volumes, a trend that has been reported across the industry, while our Wound Care business continues to work through the reset precipitated by the changes to Medicare reimbursement.

Additionally, we made significant progress preparing for the acquisition and subsequent integration of Sanara MedTech. However, as previously announced, the FTC has issued a second request for information, which extends the Hart-Scott-Rodino waiting period. We will work diligently with the commission to satisfy its inquiry, and we remain fully committed to the acquisition.

We believe the combination of the 2 companies will enhance our ability to serve the marketplace and benefit patients. By combining Sanara with our Surgical franchise, which delivered mid-teens volume growth in Q3, we will create a more compelling regenerative medicine business and accelerate the shift of our business mix towards the Surgical market.

In Wound Care, although we grew volume in targeted sites of care, the market continues to work through a range of issues resulting from the 2026 Medicare reimbursement changes. Third quarter market trends were very similar to those we reported in the first half of the year, continued disruption, pricing pressure, lower overall market volume and a gradual migration of patients into Wound Care Centers, where we achieved 7% sequential growth. Once the Wound Care market establishes a stable and predictable foundation, we believe our commitment to generating clinical evidence and to technology innovation will drive our long-term competitive advantage.

Regarding the Sanara acquisition, I would like to reiterate several key points from last quarter's call. This transaction is consistent with our well-established strategy to expand our Surgical portfolio. All of Sanara's more than $100 million in revenue is generated from Surgical procedures that are highly complementary to our business. Following the merger, approximately 75% of MiMedx's revenue will come from Surgical and 25% from Wound Care.

We believe this is an exceptionally strong strategic and cultural fit. Sanara is a growth company that is profitable and immediately accretive even before synergies. Sanara's products are 510(k) cleared and open up $4 billion in addressable markets in which we do not currently compete.

We would expect the combined company to generate run rate revenue of close to $400 million with double-digit growth. With more than $20 million in expected cost synergies, we would anticipate reaching an annual adjusted EBITDA margin of more than 20%. Taken together, these attributes illustrate why we view this as a highly beneficial combination for MiMedx and the people we serve.

Turning to the highlights of the quarter and additional details on our 2 businesses. The headline for Q3 is similar to that of last quarter. We continue to see solid growth dynamics in Surgical and a gradual recovery in Wound Care with a few notable bright spots. For the third quarter, net sales were $62 million. Surgical revenue increased 9% year-over-year with volume up in the mid-teens.

Wound Care Center unit volume grew 7% sequentially, a positive indicator for the business going forward. GAAP gross profit was 80% in the quarter, a sequential improvement of 11 percentage points. Adjusted EBITDA was $2 million, a $10 million sequential improvement. We received a significant ruling in our favor from a U.S. District Court in our challenge to the FDA's regulatory classification of AXIOFILL. As announced today, we reached a $25 million settlement and licensing agreement with one of several parties that we believe infringed on our patent portfolio.

This party elected to settle rather than litigate. We continue to litigate 2 other potentially larger cases. And we made substantial progress on our 510(k) submissions for 2 new Surgical products, including one for placental-derived product. As you know, our strategic priorities have been: number one, innovation and diversification to support both our Wound Care and Surgical businesses; and number two, targeted investments to expand our Surgical franchise.

This strategy has been highly effective. As a result, we have continued to deliver excellent growth in our Surgical segment while navigating the industry dynamics affecting the Wound Care market. Again, we believe the Sanara acquisition will play an important role in advancing our portfolio reshaping strategy.

Moving to our Q3 Surgical performance in more detail. As mentioned, Surgical net revenue grew 9% year-over-year. A closer look shows that a few discrete items in the quarter dampened an otherwise strong underlying growth rate. Specifically, Q3 2025 Surgical revenue included close to $1 million of opportunistic business-to-business placental tissue sales driven by outsized market demand.

Following the significant shift in the market, demand for these third-party sales did not recur and no such revenue was recorded in this year's quarter. Additionally, rebate adjustments increased as a result of short-term promotional activity. Excluding these items, our Surgical growth rate would have been in the mid-teens. We continue to see growth across our entire Surgical product portfolio with accelerating demand for our human placental and bovine-derived particulates as physicians expand their use across a variety of procedures.

To that end, we were pleased that the U.S. District Court of the Northern District of Georgia issued a favorable ruling in our litigation challenging the FDA's regulatory classification of AXIOFILL, our human placental-derived particulate. The court vacated the FDA's determination that AXIOFILL is not a Section 361 product and should instead be classified as a biologic product rather than a medical device.

The court remanded the matter to the FDA for further consideration. The ruling stated that the FDA had erred in its interpretation of the minimal manipulation regulation and that the agency did not adequately explain the reason behind its divergent classification of AXIOFILL compared with similar products available in the market.

Since its launch in 2022, AXIOFILL has demonstrated a strong safety profile and has supported many patients through the surgical healing process. We hope this ruling addresses any lingering concerns in the market regarding the use of this product. During the third quarter, the Wound Care market continued to work through the aftermath of the new Medicare reimbursement framework, a process that is proceeding more slowly than we had anticipated.

That said, the expected migration of patients into Wound Care Centers where we are well positioned competitively continued during the quarter. Our Wound Care Center volume grew more than 20% year-over-year and 7% sequentially. Utilization of skin substitutes in other outpatient sites of care remains well below prior year levels due to the disruptions we described on previous calls.

We remain confident that our position in the Wound Care market will benefit us over time. We are also beginning to see early traction with our PRP offering. While the proposed 2027 Medicare fee schedule did not include any meaningful changes for skin substitutes, we remain optimistic that CMS will ultimately establish baseline requirements for evidence of product safety and efficacy as a condition of reimbursement.

Accordingly, we continue to fund randomized controlled trials on 2 of our most recent product introductions and expect publications in the near future. It remains to be seen whether any changes will be included in the final rules when they are published in the coming weeks. As I mentioned on our last call, we submitted our first 2 510(k) applications for Surgical products. In recent months, we made substantial progress on both submissions and now anticipate at least one clearance before year-end.

In summary, we rightsized our cost structure to support a return to positive adjusted EBITDA and cash flow, which we achieved in Q3. Momentum in our Surgical business remains strong, and we are making good progress as the Wound Care market works through this reset phase. Once the market normalizes, we believe our market-leading technology supported by an unmatched body of clinical evidence will set the standard.

Speaking of our technology, as I mentioned, we recently entered into a $25 million out-of-court settlement and license agreement with a party we had asserted had infringed on our patents. We have 2 other active cases currently in litigation. Both cases have completed claim construction hearings with rulings that were highly favorable to our arguments. Additionally, a recent attempt by one of those defendants to invalidate our patents through an ex parte reexamination at the U.S. Patent and Trademark Office was unsuccessful, and the PTO once again affirmed the validity of the patents we are asserting. We will continue to vigorously protect our patent portfolio.

With that, I'll turn the call over to Doug. Doug?

Douglas Rice

Thank you, Joe, and good afternoon, everyone. We are excited about our pending acquisition of Sanara MedTech and the opportunities it creates for our combined organization. That said, my comments on our third quarter performance and our outlook for the remainder of 2026 are on a stand-alone organic basis and exclude any potential impact from the pending Sanara acquisition.

As a reminder, many of the financial measures covered in today's call are presented on a non-GAAP basis. So please refer to today's earnings release for further information regarding our non-GAAP reconciliations and disclosures, including the reconciliation tables that provide more detail regarding the adjustments made to calculate our non-GAAP measures.

Turning to our results. Third quarter 2026 net sales were $62 million, down 45% from the prior year period. By product category, Surgical net sales of $40 million grew 9% year-over-year and 2% sequentially during the third quarter. Notably, our Surgical franchise now accounts for approximately 2/3 of our total net sales.

And as Joe mentioned, Surgical product volume growth was up in the mid-teens as a percentage year-over-year. Within Surgical, growth remained broad-based across the portfolio. Our flagship placental sheet products, AMNIOFIX and AMNIOEFFECT and our particulate products all generated strong year-over-year growth.

We also benefited from contributions from our recently launched G4Derm Plus product, further demonstrating the breadth of our Surgical portfolio and our ability to drive growth through continued product innovation. Wound net sales were $22 million, down 71% from the prior year period. Within Wound, the business continues to be impacted by the Medicare reimbursement changes that took effect on January 1, 2026, which has had the effect of not only reducing reimbursement levels, but also volumes across the industry.

Many of the pressures we discussed on our second quarter call persisted through Q3. That said, we are encouraged by the improving activity in Wound Care Centers and hospital outpatient settings as patients continue to migrate to those sites of care. Our Wound Care Center volume grew more than 20% year-over-year and 7% sequentially, a sign of stabilization.

As we have seen all year, strong Surgical performance partially offset reimbursement-related pressure in Wound. To finish the year, we expect high single-digit year-over-year growth in Surgical and mid-single-digit sequential growth in Wound. Gross profit was $50 million compared to $95 million in the prior year period, and gross margin was 80% compared to 84%. The decline was primarily driven by lower pricing within Wound following the Medicare reimbursement changes and unfavorable product mix.

Importantly, I want to highlight the significant sequential improvement in our gross margin compared to the second quarter. Our third quarter gross margin was higher than our second quarter gross margin by approximately 11 percentage points, driven by lower production costs associated with our cost reduction initiatives, improved manufacturing throughput and ongoing operational efficiencies.

We expect fourth quarter gross margin to approximate the Q3 level as we continue to benefit from our cost reduction initiatives and improved throughput. Sales and marketing expense was $40 million or 64% of net sales compared to $54 million or 47% of net sales in the prior year period. The dollar decrease was primarily driven by our cost reduction initiatives, which resulted in lower compensation, travel and meeting expenses. We also benefited from lower commission expense, reflecting reduced sales volumes within Wound and year-over-year improvement in bad debt expense.

For the fourth quarter, we expect sales and marketing expense of 58% to 60% of net sales, reflecting the continued benefit from our cost reduction initiatives alongside our anticipated sequential increase in net sales. GAAP general and administrative expense was $19 million compared to $15 million in the prior year period. The increase was driven by $6 million of incremental legal expenses associated with our ongoing litigation matters as well as strategic and other transaction costs related to Sanara.

These costs were partially offset by lower compensation expense resulting from our cost reduction initiatives. For the fourth quarter, we expect GAAP G&A expense of approximately $18 million to $19 million, consistent with Q3. Research and development expense was $3 million or 4% of net sales, down 25% from the prior year period, primarily due to lower personnel costs following our cost reductions.

We expect fourth quarter R&D expense of approximately $3 million to $3.5 million, consistent with Q3. Our effective tax rate was 22% compared to 27% in the prior year period, reflecting certain permanent tax adjustments and deduction limitations. We continue to expect our long-term non-GAAP effective tax rate to be approximately 25%.

GAAP net loss was $9 million or $0.06 per share compared to GAAP income of $17 million or $0.11 per share in the prior year period. Adjusted net loss for the third quarter was $1 million or $0.01 per share compared to adjusted net income of $23 million or $0.15 per share in the prior year period.

The year-over-year decline primarily reflects the impact of lower profitability within the Wound segment, partially offset by savings realized through our cost reduction initiatives. Adjusted EBITDA was $2 million or 3% of net sales compared to $35 million or 31% of net sales in the prior year period.

Sequentially, our lower cost base drove a return to positive adjusted EBITDA, a favorable swing of approximately $10 million from Q2. We remain focused on executing our operating plan and expect adjusted EBITDA to improve sequentially in the fourth quarter as we continue to realize cost savings and drive improved operating leverage.

Turning to liquidity. We ended the quarter with $121 million in net cash, essentially flat year-over-year and up $2 million sequentially. During the quarter, we repaid the remaining $17 million principal balance under our Citizens Term Loan. We ended the quarter with no borrowings outstanding under our term loan or revolving credit facilities. This debt-free position and our cash balance give us significant financial flexibility as we prepare to close the Sanara acquisition.

Turning to our pending acquisition of Sanara. As previously mentioned, we have secured a commitment from Hayfin Capital for a 6-year $300 million first lien senior secured term loan initially bearing interest at term SOFR plus 6.25%.

The commitment is contingent upon the successful closing of the acquisition, at which time the facility would be funded. Together with cash on hand, the proceeds are expected to fund the cash portion of the transaction consideration. In light of the recent FTC news and the corresponding delay in closing the acquisition, we have started to incur a modest ticking fee associated with Hayfin's commitment, which will come due at closing when the transaction is funded.

As Joe mentioned earlier, we expect the combined company to generate run rate revenue close to $400 million in its first full year. Coupled with at least $20 million of identified annualized cost synergies, we also expect the first year of the combined company to deliver an adjusted EBITDA margin of at least 20%, along with strong free cash flow and a disciplined capital structure. The earnings and cash flow profile is expected to support rapid deleveraging with net leverage anticipated to fall below 3x by the end of the first full year after closing.

Turning to guidance. We are updating our stand-alone 2026 outlook and now expect full year net sales of $250 million to $260 million. We also expect modest sequential growth of adjusted EBITDA in the fourth quarter.

I will now turn the call back to Joe. Joe?

Joseph Capper

Thanks, Doug. As you have just heard, our Surgical business continues to deliver solid double-digit volume growth. The Wound Care business is still adjusting to the new reimbursement environment. But given our strong presence in Wound Care Centers, we are well positioned to benefit as the market recovers. After rightsizing our cost structure, we recorded positive adjusted EBITDA for the first time this year, and we are working diligently to satisfy the FTC's request for additional information.

In closing, I would like to once again thank and recognize the entire MiMedx team for the important work you do to positively impact the lives of the many people we serve and for the progress you have made in advancing the company's strategic shift toward a greater Surgical focus, which will better position us to serve the market and maximize the company's potential.

With that, we will now open the call to questions. Operator, please proceed with the first question.

Operator

[Operator Instructions] Our first question comes from the line of Frank Takkinen with Lake Street Capital Markets.

Perguntas e respostas

Frank Takkinen

I wanted to start with one on maybe some of the Surgical commentary, Joe. I heard the comment that there was the challenging comp with that reorder occurring. But I wanted to ask a little bit more specifically on the rebate side. Maybe talk a little bit on what led to offering the rebates? And then how should we think about kind of rebate activity on a go-forward basis?

Joseph Capper

Yes. It was some activity in the third quarter that was related to kind of new promotional work that we're doing short term through year-end and also a couple of accounts that we had active programs with that previously didn't look like they would hit targets, and now it looks like they're going to hit targets. So there might have been a little bit of catch-up in there as well. But if you look at it in the period, it was higher than what we typically record.

Frank Takkinen

Got it. Okay. That makes sense. And then I know it's a sensitive topic, and I don't think I missed it, but any thoughts on maybe an update related to the time line on when Sanara could close and any additional thoughts you might be comfortable sharing with the process with the FTC?

Joseph Capper

I don't know that there's more detail I can share with you, Frank. It's -- we got a second request, so that triggers more inquiry. We're working through that. I would say that the interaction with the FTC has been very positive. So we think and we're optimistic that we can move through this in an efficient manner. I can't comment necessarily on what the areas of further inquiry are about.

But I do think we're in good shape, and I remain pretty optimistic about working through this as efficiently as possible. And we are still very committed to the acquisition. And for all the reasons we outlined on the last call and this call, we think it's a really good fit for us. It will be accretive right out of the gate, and it fits squarely into what our strategic intent has been for the last 3-plus years. So not a whole lot of new color I can provide, unfortunately. As we learn more, we'll certainly share that with you. And I certainly don't want to put a time line on it because it's outside of my control.

Frank Takkinen

Right. All right. Okay. Fair. Maybe just one last one for Doug. I heard the comments about 80% gross margin staying durable through Q4. Is it fair to think that, that profile can kind of stay durable on the go-forward basis into 2027 and beyond? Or how might we think about gross margin on a longer-term time frame?

Douglas Rice

Yes. Our ops team has done an outstanding job following our cost reduction activity in the spring. We've gotten a ton of manufacturing efficiencies, improved throughput. Going forward, I think a lot of it is going to depend on product mix, but we certainly like where we think we're going to exit the year.

Operator

Our next question comes from the line of Chase Knickerbocker with Craig-Hallum Capital Group.

Chase Knickerbocker

Joe, maybe just on your Wound business strategically, a little bit higher level. I mean, do you feel like you have any better visibility to where this business stabilizes now versus last time we got an update in August? You noted expectations here for sequential growth in Q4. Any thoughts there that are a little bit more forward-looking on this business potentially stabilizing and when would be helpful.

Joseph Capper

Yes. This is probably the toughest one to predict, Chase. We're only 3 quarters into this reset. Just as a reminder, we came into this year having just realized we're losing probably 42% of our 2025 revenue, all at a high gross margin. So if you look at it on a gross margin perspective, we probably lost $145 million of 2025 revenue and we had to work through that, while the industry itself was resetting. With all the conditions that we've talked about on this call and prior calls, there's still a lot of noise out there.

We do think we're in a good strong relative position, especially in Wound Care Centers where our message tends to resonate more. But what the thing -- where it finally settles out and stabilizes from a volume and price perspective is still a little difficult to pinpoint. And then what kind of growth rate we will realize on top of that once we sort of baseline the industry. So I know it's tough to model. It's tough for us to model. I would just say that when it settles down, we do think we're in a very strong relative position. I think it's companies like us that will ultimately be there when all the dust settles.

Chase Knickerbocker

Got it. Maybe turning to Surgical. I hear you on the kind of one-timers in Q3. Just as we think about Q4, you kind of noted for high single-digit growth in Q4. Are there any additional one-timers that we should be thinking about for that business in Q4? Or is that kind of the growth rate we should be kind of thinking about near term as we kind of turn into early '27 as well?

Joseph Capper

Yes. I don't think you're going to see as much noise in Q4. Certainly, the -- I don't think you'll see it on the rebate side. We didn't sell as much placental tissue B2B last year in Q4 because the industry was predicting the change. That was all opportunistic sales. We had dumped them in our Surgical line last year. So we take that out, Q3 growth rate looks more like 12% short of that. And I think we feel real good about how the business is trending and what we're looking at for Q4, but that we shouldn't have as much noise in Q4.

Chase Knickerbocker

Got it. Maybe just last for Doug. If we think about kind of the delay caused by the second request, I know it's a little bit difficult on timing, but just any sort of different thoughts on kind of time to achieving that synergy target or kind of time to achieving that 20% EBITDA margin level as we think about '27?

Douglas Rice

We're chomping at the bit to get going. I still think we feel good about those being first year targets. It's just a question now of when that first year is able to begin. But we're still looking at $20 million plus of OpEx synergies for all the -- in all the areas that we've discussed before in terms of -- mostly out of G&A, and we haven't seen anything to change our view on being able to achieve those quickly.

Joseph Capper

We were originally working towards this like an October close time frame prior to the second request. And we have done, between our organization and Sanara, a ton of work in preparation for the ultimate close and integration. So we again have gotten more and more comfortable with those numbers. But for Doug's comment, it just all depends on when we hit go.

Operator

[Operator Instructions] Our next question comes from the line of Anthony Petrone with Mizuho Securities.

Bradley Bowers

You have Brad Bowers on for Anthony. Just wanted to hear one on just the clinical study strategy. R&D, I think we had expected to go up and maybe be an offset on that EBITDA line came down a bit. I understand there's some timing here, but wanted to see if you still think you need the clinical studies. Obviously, I think the Wound segment would have been the beneficiary of that, but I just want to make sure that we understand that.

Joseph Capper

Yes. We are still investing in clinical studies, and we think they're really important. We've got a commitment to evidence generation. I think I mentioned in the script that we have 2 active randomized controlled trials on our latest products. We're funding them. Some of the spend may have been associated with reaching full enrollment in at least one of those as well. But yes, a total commitment to generating evidence.

Bradley Bowers

Got it. That's helpful. And then I'm going to ask another question that someone else asked, but a different way. Just on that 20% EBITDA margin kind of for the total organization, do you -- to what extent, I guess, do you need Wound Care to come back to achieve that 20% level? Are there some inefficiencies, obviously, from the way that business is -- or at least the market is performing? And just to what extent could Surgical lead the way towards 20% if we want to assume that the Wound Care business does kind of remain sluggish?

Douglas Rice

We feel good about -- we certainly like Wound Care to continue to grow and believe it will at some point. As Joe indicated earlier, the market is still settling from the CMS reset that we got this year. But we're good with where we are with Wound and achieving our 20% target, we believe, is certainly within sight in a fairly short amount of time.

Bradley Bowers

That's helpful. Maybe just one more on maybe where that stands. Just want to make sure that there isn't any -- I know in the past, we had talked about some political efforts or some other, I guess, catalyst points for the Wound business. Do we expect just gradual recovery off this floor? Is there any inflection point that is on your calendar?

Joseph Capper

No. I mean the only scheduled event is the publication of the fee schedules, Medicare fee schedules, which typically happen in November. So we'll see if anything changed from proposed fee schedule in July to final in November, but we really don't anticipate much change. I think Smart Money is probably what we see in '26 is probably what we're going to see in '27.

Operator

There are no further questions at this time. I'd like to pass the call back over to Joe for any closing remarks.

Joseph Capper

Thanks, operator. Before we close out, I'd just like to kind of remind everybody where we were 3 quarters ago. I mentioned it to Chase. We had just learned that we had lost 42% of our 2025 revenue and had to recover from that. In 2 quarters, we recovered to full profitability and positive cash flow.

The Surgical -- we had Surgical growth despite soft procedures in the quarter, which I think is outstanding given all the other things we had, all the other activities we have going on in the company. We continue to invest in research and development, as I just discussed. We had this big AXIOFILL win.

To put that in perspective, it was about 2.5 years ago that we found out that the FDA had an issue with that. We decided to go through a process to contest that and we prevailed during that time period. We sold about $30 million of AXIOFILL. Big IP settlement win, and we have a few more in the funnel. We put ourselves in position to acquire a highly attractive and accretive asset in Sanara. So we're pretty pleased with where we are. I'd call the quarter kind of flat sequentially given some of the noise that we talked about, but we're pretty excited about where the business is.

With that, let's close, and we'll talk to you all next quarter. Operator, that concludes the call.

Operator

Thank you. Thank you, everyone, for your participation. You may now disconnect.