Article révisé par les pairs
Résumé : Limbedemas of lymphatic origin, either primary, or secondary, represent a chronic disease sometimes heavy to bear by patients who suffer from them. These lymphedemas imply specific care by physical therapists trained to the use of different therapeutic approaches. Until a few years, only the treatments of secondary lymphedemas after radiotherapy and/or complete nodal dissection for cancer were reimbursed by the national health insurance system in Belgium. The introduction of the primary congenital lymphedemas as a disease also reimbursed raised several problems and led to a redefinition of these situations and of their cares. The definition and classification of the lymphedemas in view of the reimbursement of their treatments by the national health insurance system are now officially based (not only on the sole clinical history but) mainly on their clinical severity and/or also on the result of their lymphoscintigraphic investigation (according to a methodological protocol and to diagnostic criteria adopted at the national level). The reimbursements of the treatments by the physical therapists were also adapted and improved. The lymphocintigraphic investigations of the limbedemas became so essential in the management of the lymphedematous situations and in the reimbursement of their physical treatments in Belgium. © 2010 Elsevier Masson SAS.