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This review provides an overview of the current scientific data as well as new clinical developments in various fields. It also reviews the current legal situation.<\/jats:p><jats:p>A literature research was carried out to survey the current status of relevant data. Written inquiries to several German institutions (Institute for Quality and Efficiency in Health Care, National Association of Statutory Health Insurance Physicians, Center for Clinical Studies T\u00fcbingen, <jats:italic>Federal Institute for Drugs<\/jats:italic>\u00a0and Medical Devices) were made to determine the legal situation.<\/jats:p><jats:p>No evidence was found in the literature for a causal relationship between the use of epinephrine as a vasoconstrictor and necrosis of the finger or penis. Studies and reviews show that the use of local anesthetics with epinephrine on the fingers or penis is a safe procedure with many clinical and economic advantages. In routine clinical practice, the WALANT method (Wide Awake Local Anesthesia No Tourniquet) as well as the increasing incidence of skin tumors in acral areas has led to a tendency towards increasing use. However, its use is still legally contraindicated, and the pharmaceutical companies show no interest in supporting a drug study. Further clinical trials \u2013 regardless of the strength of the evidence \u2013 would not change the current legal contraindication.<\/jats:p>","DOI":"10.1111\/ddg.14434","type":"journal-article","created":{"date-parts":[[2021,2,18]],"date-time":"2021-02-18T03:32:19Z","timestamp":1613619139000},"page":"185-196","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Use of local anesthetics with an epinephrine additive on fingers and penis \u2013 dogma and reality"],"prefix":"10.1111","volume":"19","author":[{"given":"Saskia Maria","family":"Schnabl","sequence":"first","affiliation":[{"name":"Department of Dermatology University of T\u00fcbingen  Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franziska Carola","family":"Ghoreschi","sequence":"additional","affiliation":[{"name":"Department of Dermatology Venereology and Allergology Charit\u00e9 \u2013 University Medical Center Berlin  Berlin 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