Cranioplasty using a synthetic material is less than ideal, especially if there is a history of infection at the defect site. Split-rib cranioplasty is a practical approach even in patients with a positive history of infection at or around the defect. We briefly review the historical background of split-rib cranioplasty and report our experience with this procedure in 12 patients. Forty-two pieces of rib, with an average length of 13 cm. were used for reconstruction. We had only 1 complication-a pneumothorax following removal of the rib graft. The follow-up period ranged from three to thirty-six months. All patients had complete regeneration of the donor rib and solid protection of the brain.