Plastic surgeons have long searched for the ideal materials to use in craniomaxillofacial reconstruction. The aim of this study was to obtain a novel porous elastomer based on designed aliphatic polyurethane (PU) and nanosized hydroxyapatite (n-HA) fillers for plastic reconstruction. The physicochemical properties of the prepared composite elastomer were characterized by infrared spectroscopy (IR), X-ray diffraction (XRD), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX), transmission electron microscopy (TEM), thermal analysis, mechanical tests, and X-ray photoelectron spectroscopy (XPS). The results assessed by the dynamic mechanical analysis (DMA) demonstrated that the n-HA/PU compounded foams had a good elasticity, flexibility, and supporting strength. The homogenous dispersion of the n-HA fillers could be observed throughout the cross-linked PU matrix. The porous elastomer also showed a uniform pore structure and a resilience to hold against general press and tensile stress. In addition, the elastomeric foams showed no evidence of cytotoxicity and exhibited the ability to enhance cell proliferation and attachment when evaluated using rat-bone-marrow-derived mesenchymal stem cells (BMSCs). The animal experiments indicated that the porous elastomers could form a good integration with bone tissue. The presence of n-HA fillers promoted cell infiltration and tissue regeneration. The elastomeric and bioactive n-HA/PU composite foam could be a good candidate for future plastic reconstruction.