재활의학과 전문의 관점에서 본 진피역류

More or less 50 years passed since so-called “dermal backflow” phenomenon had been reported first in 1970s. To clear unintegrated definition and its pathophysiologic meaning of dermal backflow, a narrative review was conducted in this article. The mostly accepted definition of dermal backflow is the pathophysiologic response of lymph flow through lymphatic capillaries and precollectors to the occlusion of superficial lymphatic collector vessels in lymph edema patients. Dermal backflow has binary features simultaneously and/or respectively: pathologic reaction of lymph flow retention versus physiologic reflection of alternative pathway to impaired lymph flow; in which way it works depends on remaining capability (function, dysfunction, or nonfunction) among the corresponding lymph capillaries, precollectors, and superficial lymphatic collectors in practical terms of 3-dimensional anatomic basis. Although assessment under this kind of view is critical in making plans for treatment - such as remedial massage and manual lymphatic drainage relying on intact lymphosomes, and selection of a targeted vessel in lymphovenous anastomosis -, it is not practically available in the clinical situations now. However, due to rapidly developing medical imaging technology such as photoacoustic lymphangiography and magnetic resonance lymphangiography with high-performance gradients, it is expected to assess functional status of specific lymphosomes in 3-dimension in the near future.