We present our personal experience with 650 children suffering from obstetric brachial plexus palsy. We describe the related surgery including early microsurgical nerve reconstruction and later tendon and muscle transfers. We discuss our clinical approach, the indications and timing for surgery, the technical details of primary and secondary surgery in our hands, and the possible outcome. We emphasize that both clinical work and research work need an interdisciplinary team approach and that diagnostic, therapeutic, and prognostic improvement is based on the refinements of our (micro)surgical skill and the continuous exchange of information between specialized centers.KEYWORDS: Obstetric brachial plexus palsy, microsurgery, tendon/muscle transfers, cocontraction, movement analysis We describe our personal journey into the complex field of reconstructive surgery for children suffering from obstetric brachial plexus palsy (obpp). We share our 9-year experience with our group of patients, where we established and verified surgical procedures for nerve repair, joint contracture releases, as well as tendon and muscle transfers. Furthermore, we describe our strategy and results and compare them with the results reported in the international literature and the opinions of experts met in workshops and specialized seminars.The international literature on this subject is very rich, so we limit the reference list in this article to milestone papers. We do not discuss all published comments, possible technical refinements, and results unless they seem very important for our daily approach to these children.We would like to honor the cooperative spirit we share with our anesthesiologists, pediatricians, orthopedists, neuropathologists, research engineers, physiotherapists, and, last but not least, all the parents in Germany, who continuously stimulate our daily work through their questions, hints, support, and gratefulness.
