We have successfully treated 4 patients with large cranial defects using a composite of allogeneic cranial bone, BMP (bone morphogenetic protein), pedicled periosteum and skin flap. The size of the cranial defects ranged from 9 cm x 7 cm to 13 cm x 11.5 cm. One to two years' follow-up showed that the wounds in all patients healed primarily with good appearance. The allogeneic bone graft was absorbed and substituted by new bone formation.