AbstractThe purpose of this report is to present our 5‐year experience in reconstructing large bony defects in the cranial vault of 16 patients. The method employs an alloplastic implant device made of elastomer‐coated cloth mesh, used in conjunction with bone grafting [D. L. Leake and M. Habal,J. Biomed. Mater. Res.,10, 555 (1976)]. The cranial defects ranged in size from 6 × 6 cm to 15 × 17 cm. The defects were in the frontal, temporoparietal, and occipital regions. Particularly challenging was the frontal‐orbital region involving the superciliary ridges. The alloplastic implant provides controlled contour of the bone graft material while providing strength and stability during healing. The implant has adequate but not complete rigidity, allowing adaptability in the operating room. The elastomer used is a polyetherurethane. Any biocompatible cloth mesh can be used, but Dacron [poly(ethylene terephthalate)]was chosen because of its extensive implant history.Contrasted with reconstruction using only bone, where as many as half of the cases had uneveness and were found to be aesthetically unsatisfactory, the technique described here has resulted in aesthetically excellent results and an intact neurocranium in the 16 patients studied t