We present a personal experience with 750 children suffering from obstetrical brachial plexus palsy. The related surgery is described, including early microsurgical nerve reconstruction and secondary procedures including tendon and muscle transfers. The clinical examination, indications and timing for surgery, technical details of primary and secondary operations and the possible outcome are discussed. Both clinical and research work need an interdisciplinary team approach, and diagnostic, therapeutic and prognostic improvement is based on the refinements of microsurgical skills and the continuous exchange of information between specialized centers.