From Dilemma to Breakthrough: Prospects for Clinical Application of Exosome-Hydrogel Systems in Diabetic Wound Repair.

Diabetic wounds are refractory due to persistent inflammation and impaired angiogenesis, with traditional treatments having limited therapeutic effects. As promising cell-free therapeutic agents, exosomes can regulate wound inflammation and accelerate angiogenesis, while their clinical application is restricted by rapid in vivo clearance and short wound retention time. Functional hydrogels with excellent biocompatibility and sustained-release performance serve as ideal exosome carriers to construct intelligent composite dressings that break multiple healing barriers. This review summarizes the pathological mechanisms of diabetic wounds, the repair mechanisms of exosomes, and the fabrication strategies of exosome-loaded hydrogels. It also analyzes current challenges and prospects for the artificial intelligence-empowered research and clinical translation, providing theoretical references for the development of novel diabetic wound repair materials.