Purpose: Despite advances in the management of complex diabetic foot disease and CLTI, major limb amputation remains common. Post-operative wound care is a key determinant of recovery following below-knee amputation (BKA), influencing infection, wound dehiscence, revision surgery, contracture formation, and chronic pain. While standardised wound care pathways have been proposed, they are often difficult to apply in patients with complex wounds. This review presents a single-centre experience in managing complex BKA wounds, examining outcomes, complications, and alternative wound care strategies when conventional protocols are unsuitable. Methods: A focused literature review was undertaken to evaluate contemporary surgical and post-operative wound management strategies for BKA, including flap design, wound closure, dressing selection, timing and frequency of wound review, and residual limb shaping protocols. This was followed by a review of three complex BKA cases managed at The Canberra Hospital between 2025-2026. Key lessons regarding optimal post-operative wound management were identified. Results: In selected patients with significant post-operative oedema, delayed wound closure may improve healing. Negative pressure wound therapy and compression prior to application of rigid dressings may optimise wound healing and residual limb maturation. Wound products including collagen-based scaffolds may be beneficial in chronic, heavily exudative wounds or where flap tissue quality is poor. Successful management was consistently associated with multidisciplinary care involving surgeons, specialist vascular nurses, allied health practitioners, and prosthetists. Conclusion: Although standardised post-operative wound care pathways offer advantages in streamlining care and education, they are often insufficient for complex BKA wounds. Individualised management within a multidisciplinary framework is essential to optimise healing, preserve function, and improve patient outcomes.