The functional and morphological features of the peripheral initial lymphatics comprise the mechanical stimulation-dependent lymph formation and irregular shapes of the lumen. A small amount of lymph formation is observed in the tissues of the extremities without mechanical stimulation. However, a skin massage markedly increases lymph formation, even if the massage frequency is an extremely low rate of 0.03 Hz. 1,2 Other mechanical stimulation such as arterial pulse, 3 joint movement, 4,5 and vibration 6 enhances lymph formation in the peripheral tissues. In the skin and subcutaneous tissue, the luminal pressure of the initial lymphatics is higher than that of the interstitial fluid. 7-9 To explain the mechanisms of lymph formation against the pressure gradient, several hypotheses have been proposed to date. 7 In these hypotheses, a two-valve system that comprises an initial lymphatic endothelial microvalve and a collecting lymphatic intraluminal valve is widely accepted as a structure to convert external forces into a one-way flow of fluid from the interstitial space to the lymphatic lumen 10 (Figure 1A). Although the two-valve system theory can explain the mechanisms