Thomas John Starling Patterson (TP) was a consultant plastic and reconstructive surgeon in Oxford. He was born on 27 November 1920 in Melbourne, where his father, Sydney Wentworth Patterson, was working as a physician. His mother, Muriel Patterson née Starling, was the daughter of Ernest Starling, an eminent physiologist known for Starling’s law of the heart, who also established the idea of semipermeable capillary walls and the principles of fluid balance, discovered secretin and coined the word ‘hormone’. Also among his mother’s relations, his great grandfather was Sir Edward Sieveking, physician to Queen Victoria. Returning to England, TP was educated at Marlborough. He already had an adventurous streak and remembered sneaking out of his school house in the middle of the night and cycling 20 miles (in the rain) to see the sunrise at Stonehenge (unfortunately invisible), then back to school undetected, before the house awoke. Before going to Cambridge, he spent two terms at Basel University, where he learnt German and continued to fence – he had been captain of his school fencing team. In Basel, he was surprised by the lively duelling ethic, using sabre as opposed to safe epee swords. It was taken for granted that Tom would pursue medicine, as had four generations before him. He went up to Cambridge in 1939, at the beginning of the Second World War. The three-year preclinical course was condensed into two years and the students were recommended to join the Home Guard. He had vivid memories of night exercises with fields of burning crops due to incendiaries. He went on to St Thomas’ Hospital in London for his clinical studies and anticipated a career as a physician, but decided on surgery after a ward round with a surgical registrar particularly impressed him. Tom remembered realising: ‘dear God, here’s a chap who can operate and he can actually think’. In wartime London, medical students were left to get on with things they were thought able to deal with, including the regular tonsil list. In 1944, Tom witnessed the first use of penicillin at St Thomas’ when he was involved in the treatment of a policeman who was dying from an infected hand. The penicillin powder was sprinkled on the wound and the man’s life was saved: the penicillin was extracted from the patient’s urine and used again. Once qualified, TP became a resident surgical officer in the ‘sector’, St Thomas’ being scattered all over Surrey. He felt fortunate to work for Walter ‘Gaffer’ Mimpriss, who was then one of the junior surgeons, to whom he attributed his extensive general surgical training. By the end of the war St Thomas’ was receiving regular convoys of wounded serviceman back from France: this provided great experience in the management of unhealed wounds, which Tom tackled together with an orthopaedic registrar. Further training with Sir Harold Gillies at Rooksdown House convinced him he should continue with plastic surgery. In 1957 TP was appointed as a consultant at the Churchill Hospital in Oxford alongside Eric Peet, taking over when Thomas Kilner, who held the first Nuffield chair in plastic surgery, retired. After some initial difficulties when Kilner refused to relinquish his office or his out-patient clinics and operating lists, TP set about reforming the department, making links with other specialties, including radiotherapy, trauma surgery, maxillofacial surgery and dermatology. He also established research projects in the Nuffield department of surgery with Philip Rowland Allison and later with Sir Peter Morris, which led to some important work with Stuart Milton on blood supply of skin flaps in the immediate pre-microvascular surgery era, working with pigs and also establishing microsurgical models in rats. He also extended the use of intravenous dyes to predict flap survival, and studied amniotic band syndrome. In 1959, he gave a Hunterian lecture on congenital deformities of the hand. With Des Oliver, who was running the haemodialysis unit, he worked on techniques to create Brescia-Cimino fistulae for dialysis patients, and also supported the initiation of renal transplantation at the Churchill Hospital. In 1968, with Joe Smith, a urologist, TP performed the first renal transplant in Oxford. He also developed an active head and neck cancer practice in collaboration initially with Frank Ellis, a radiotherapist, and a consultant clinical oncologist George Wiernik. They developed ways of maximising the benefit of combined surgery and radiotherapy, including a technique of surgical excision with flap repair and parallel plastic tubes placed beneath the skin flap through which irridium wires could subsequently be threaded to deliver a high but very localised dose of radiation. Tom had a cordial relationship with Eric Peet, his senior colleague. They were very different: Eric was a technically adroit surgeon, who took great pleasure in the technical precision of his surgery, and had a large private practice; Tom was an academic surgeon, technically adventurous but grounded in general surgical philosophy, with never any appetite for private work. With Peet, TB wrote a fine textbook *Essentials of plastic surgery* (Oxford, Blackwell Scientific Publications, 1963). He also contributed to *The McDowell indexes of plastic surgical literature* (Baltimore, Maryland, Williams and Wilkins Co, c.1971-77), translated *The Zeis index and history of plastic surgery, 900 BC-1863 AD* (Baltimore, Maryland, Williams and Wilkins, c.1977) from the original German, produced the *Patterson index of plastic surgery* (William Wilkins, 1978), in which he collected all plastic surgery literature between 1864 and 1920, and, in 1988, published a translation of Eduard Zeis’ 1838 work *Hanbuchen der plastischen chirurgie* as *Zeis’ manual of plastic surgery* (Oxford, New York, Tokyo, Oxford University Press). In 1978, he retired from surgery to take up a post at the Wellcome unit for the history of medicine in Oxford, where he studied the role of the East India Company in introducing western medicine to India. He was widely respected among medical historians and became an indefatigable writer, producing, with G D Singhal, a *Synopsis of Ayurveda* (Delihi, Oxford, Oxford University Press, 1993) and *The East India Company and medicine in India* (2012). He also tackled more diverse subjects, including *Chamber music miscellany* (2006), *Maps and socks: a walker’s miscellany* (2013) and a biography of the educationist, poet and essayist Arthur Hugh Sidgwick, published in 2017 when TP was 96. He had many interests, including music; he was an enthusiastic amateur viola player, enjoyed chamber music ensembles and for many years had a major role in the running of the Headington chamber music course, attended by amateur players from around the country. Tom Patterson was a lively, warm, vivacious man with a sharp sense of humour. He was a superb surgical teacher, modelled on the style of teaching he had enjoyed – by example, followed by supervision, followed by independent working. In 1944, he married Sonia Scott-Fleming. Although they separated in mid-life, they remained close and shared a four-storey house close to the old Radcliffe Infirmary, living on two floors each. They were both slightly eccentric: dinner when they were together in their house at Kidlington was in the kitchen, with some of their cats wandering past across the table. TP remained relatively independent in a sheltered environment almost to the last, retaining full mental capacity, although weakening physically. Near the end, he wrote to say that he now understood the meaning of the expression ‘last legs’. He died on 31 October 2020 after a short illness following a fall, four weeks short of his 100th birthday. He was survived by two daughters, Belinda and Judy, and three grandchildren, Tamsyn, Jessica and Ben.