Submitted as per conditions of 2023 ANZSVS grant: Introduction: Below-knee amputation (BKA) has a devastating impact on function, and progression to prosthetic fitting is a crucial milestone. Rigid removable dressings (RRDs) are protocolised in some regions to promote successful orthosis, however there’s limited evidence to guide optimal dressing choice. This New Zealand-based multi-centre study (in collaboration with the NZ Artificial Limb Service) presents one of the largest cohorts of patients to address the question: do RRDs alter surgical and functional outcomes following BKA? Methodology: A retrospective cohort study was conducted according to STROBE guidelines. Patients who underwent primary BKAs in four tertiary centres between 2009 and 2022 were included. Exclusion criteria were previous contralateral amputations, a subsequent (contralateral) amputation within 12 months, and paediatric cases. Surgical outcomes were length of hospital stay (LOS), return to theatre (RTT) and mortality. Functional outcomes were time to initial assessment (a surrogate for stump healing time) and prosthetic fitting, and long-term mobility and quality of life scores. Results: Of the total 1007 patients included, 470 (46.7%) received a RRD, 489 (48.6%) were fitted with a soft dressing, and for 48 (4.7%) dressing type was not recorded. Median time to initial assessment was 13 days shorter (74 vs 87 p=0.001). The RRD group had 0.72 [0.54 – 0.97 p=0.03] odds of returning to theatre. There were no differences in LOS, adjusted mortality, time to prosthetic fitting, or mobility and quality of life scores. Conclusion: Times to initial assessment and rates of return to theatre were reduced in the RRD cohort. These findings are consistent with international literature and guidelines, and lend evidence to support the routine application of post-op RRDs post-BKA. While a randomised controlled trial may not hold equipoise, this data should be correlated with multi-centre studies from other regions.