Background <p>The T-incision approach for internal hemipelvectomy necessitates extensive dissection to expose the posterior pelvic structures, leading to higher rates of wound complications. A modified separated-incision approach was developed and validated in this comparative study.</p> Patients and methods <p>The separated-incision approach used two distinct incisions: an anterior incision that combines the ilioinguinal approach with a short, straight Smith-Petersen incision; and a separated posterior incision for the posterior pelvic structures. This approach was applied to 8 patients with internal hemipelvectomy related to type II + III regions. Seventeen patients underwent a traditional T-incision approach during the same period were matched for comparison.</p> Results <p>The separated-incision approach was successfully performed in these eight patients, preserving the gluteal vessels and posterior skin-muscle flap. Lower blood loss (2375 vs. 3952 mL, <i>p</i> = 0.005), and similar operative time (312 vs. 398&#xa0;min, <i>p</i> = 0.098) was observed. Postoperative haemoglobin was higher (88.1 vs. 74.8&#xa0;g/L, <i>p</i> = 0.009), and drainage volumes were marginally reduced (1379 vs. 1917 mL, <i>p</i> = 0.209). Compared to 8 patients in the T-incision group who experienced wound complications including delayed wound healing (<i>n</i> = 4) and surgical site infection (<i>n</i> = 4), all patients in separated-incision group achieved primary wound healing within 3 weeks (47% vs. 0%, <i>p</i> = 0.026). Additionally, they had a shorter time to ambulation (39 vs. 62 days, <i>p</i> = 0.015) and higher MSTS scores (24.25 vs. 20.47, <i>p</i> = 0.006). No differences were observed in local recurrence or overall survival.</p> Conclusions <p>The separated-incision demonstrated fewer wound complications and faster mobilization, suggesting it is a promising alternative; multicentre validation is warranted.</p> Level of evidence <p>Level III, Retrospective cohort study.</p>