Internal hemipelvectomy was used to treat recalcitrant pressure sores in the absence of flap options following leg fillet. The bony hemipelvis was resected in the sub-periosteal plane, resulting in the removal of the iliac wing, ischium, and pubic rami. This procedure creates enough mobile soft tissue to allow even large ulcer defects to be closed primarily. We have used the technique successfully in 5 patients; follow-up ranged from 4 to 30 months. Internal hemipelvectomy is a treatment option for end-stage pressure ulcers in lieu of hemicorporectomy.