Double approach for internal hemipelvectomy: Pararectal and Kocher Langenbeck incision

Background: Internal hemipelvectomy is the preferred treatment option for localized pelvic sarcoma if good functionality is expected in the remaining limb. Wide exposure is crucial for identifying major neurovascular structures in proximity of the tumor. The utilitarian approach and its modifications are the standards to achieve this goal, unfortunately associated with a 35% risk of wound problems and flap ischemia. The pararectal incision provides excellent access to the pelvis, retroperitoneum and even the femoral region.