Obituary for Ronald Wellesley Pigott

      Ron Pigott, who died peacefully at home at the age of 87 on 17th February 2020, was one of the most influential Plastic Surgeons of a generation, especially in the field of cleft lip and palate.
      The quintessential English gentleman, Ron actually carried an Irish passport. Born on 16th September 1932 in Isfahan, Persia (now in modern day Iran), his father was a general practitioner, who settled in Kettering. Ron went to Oakham School, which he never mentioned. What school one went to did not bother him, only one's ability. He went to medical school in Dublin (BA Dublin 1954, MB ChB BAO Dublin 1956) where he excelled at sport. He was an Irish international hockey player (1954) and he played both hockey and tennis for the University of Dublin.
      Ron's general surgery rotation was at the Hammersmith Hospital, London, and he was awarded the Fellowships of the Royal College of Surgeons of Ireland in 1960 and of the Royal College of Surgeons of England in 1962. Ron took a short service commission with the British Army, Parachute Field Ambulance from 1960-62 and he then went into Plastic Surgery training. He worked at Odstock Hospital, Salisbury under John Baron and then went to Stoke Mandeville Hospital, where he was Senior Registrar under J P Reidy until 1968.
      Ron married Sheila, who was a State Registered Nurse and Midwife, in 1958 and they had four boys. He was immensely proud of his family. Ron continued to play tennis for many years and the tennis tournament at the Pigott's summer party, held at their beautiful house in Gloucestershire, was always very hard fought. Ron and Sheila were consummate hosts but, at one such party it became clear who was the ‘Boss’ at home. When asked where a new brand of peanut came from, Ron replied to the perplexed SHO, “I don't know….I just come home and they are here”. Ron travelled with his tennis racket to the international Cleft Congresses, where he would play the likes of S.T. Lee (Singapore), Sam Noordoff (Taiwan) and Peter Randall (USA), the elite cleft surgeons of the day. Ron never said who won.
      Ron had a lifelong love of the arts and of painting and sculpting in particular. The Pigott's Christmas card was a pen and ink, limited edition print of one of his original sketches of a scene in and around Bristol. I still have all mine and I believe I am not alone in doing so. Ron loved to go on painting trips with friends and colleagues, particularly John Lendrum and Brian Morgan. He also loved gardening and walking his dogs, the whippets. His generation of surgeons was not immune from driving fast cars. Ron's Gold Porsche 924 turbo was part of him.
      Having developed a special interest in the management of cleft lip and palate, Ron spent a year as the Robert Johnson Fellow with the eminent US cleft surgeon Ralph Millard in Miami. As part of his Fellowship, Millard asked him to investigate a procedure which he had devised, known as the Millard island flap, which involved using a small segment of hard palate mucoperiosteum to lengthen the nasal layer of the palate. Ron overcame earlier difficulties in endoscopy of the nasopharynx by using the newly developed Storz Hopkins rod lens endoscope, at the same time that Dr. M L Skolnik, a radiologist, was developing cineradiography (before the development of video). Together, they began to understand how the palate functioned and why so many palate repairs were unsuccessful and began to tailor secondary surgery to the size and nature of the defect. Interestingly, Ron apparently did not tell Millard that his operation was not effective!
      Ron was appointed as a consultant Bristol in 1969 and continued his work on understanding the palate and inspired a generation of surgeons to share his fascination with palate repair and the correction of inadequate palates. Working with Tony Makepeace, a technical expert who designed and made the first ‘split screen' to simultaneously display and record the X-ray and the endoscopy as Ron performed the investigation. Ron and an American speech pathologist Dr Bob Shprintzen, independently developed a theory that the problems with the cleft palate were due to the lack of paired musculus uvulae, on the dorsum of the soft palate, and he devised a procedure to attempt to replace it with a flap of oral mucosa (which he described as the “tadpole flap”). He was initially sceptical of the concept that the problem was the orientation of the palate muscles (especially the levator veli palati) and that the correction of these was a better solution. However, typically he came around to supporting this idea. He was much more interested in trying to find the answer than in defending his position.
      His other major interest, especially in cleft surgery, was the correction of the nasal deformity. He developed a new procedure, known as the” leapfrog”, to correct the deformity of the alar cartilages. Again, he was happy for this to be compared with the alternative technique devised by Harold McComb in Australia and, when his registrar, Nigel Mercer, showed the symmetry gained by his operation at the age of 10 was worse than that of the ‘McComb’, he acknowledged that the ‘McComb’ technique produced better results and stopped performing his procedure.
      His obsession with the achievement of nasal symmetry in cleft lip repair continued well into his retirement and, together with his younger brother, Brian, developed a computer programme (Symnose) to measure lip and nasal symmetry. He was presenting and debating this in meetings of cleft surgeons well into his 80s.
      These examples demonstrate his lifelong pursuit of excellence, his determination to find answers, his infectious enthusiasm, his humility and his generosity towards others. In an age when the surgeon often regarded himself as boss, he recognised the importance of being a team of equals. He did not mind which school or University his surgical team went to but he did demand complete dedication to improving the results for patients with cleft.
      Ron was an exacting boss and held strong views strongly but he was also inspirational in his love of cleft surgery. Such was his international reputation that there was a long standing exchange with Australasia at Registrar level. During their year long tenure, they all spent 6 months on the Pigott firm. Interestingly and characteristically, ‘RWP’ (as he was referred at Frenchay) did not realise working with him was the ‘main attraction’. One of the ‘terrors’ for his team was him saying, after injecting the local anaesthetic, ‘Entertain me!’, whilst he waited 7 minutes by the clock for the local and adrenaline to act. They could be a long 7 minutes….
      Ron instigated Multi-Disciplinary Team care, performing joint clinics and, with Liz Albery, the internationally renowned speech and language therapist, and Ian Hathorn, the nationally renowned orthodontist, he created such a team in Bristol. Just before he retired, Nichola Rumsey, the internationally renowned healthcare psychologist, also attended his clinics.
      In the 1980s, evidence began to accumulate that the growth of the cleft maxilla following surgery in the United Kingdom was inferior to those from Oslo, Norway. The discussions and arguments amongst surgeons performing cleft surgery lacked scientific vigour and Ron was the only one who insisted that audit of consecutive case records must be used to determine the longterm outcomes of patients with cleft. He challenged other surgeons, ‘Show us 10 consecutive cases!’ He did as he demanded of others and he acted on the results both positive and negative. As a result of his work, there is an almost complete record of the cases treated in Bristol dating back to the 1970s. Perhaps one of the sadnesses for cleft care is that he did not write more on his overall, longterm results after his retirement and, in particular, on his unparalleled archive of early cleft palate speech investigation.
      Ron was the President of the European Association of Plastic Surgeons (EURAPS) from 1992-93 and of the British Association of Aesthetic Plastic Surgeons (BAAPS) in 1993. He received both the James Berry Prize and the Jacksonian Prize in 1979 and received the Mowlem Award from the British Association of Plastic Surgeons in 1982. He was listed in Who's Who in 2007, an accolade for any surgeon.
      He was, undoubtedly, the role model for a generation of cleft lip and palate surgeons. He was enormously influential in his field and was often called upon to advise on cleft care internationally.