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Autologous nerve grafting, the gold standard for repairing PNI, remains limited by certain donor site morbidity, and alternative approaches include cell therapy, nerve conduits, gene therapy, and electrical stimulation with immune rejection and ethical controversies. Yet, hair follicle neural crest stem cells (hfNCSCs), a pluripotent cell population originating from the embryonic neural crest, have emerged as a promising candidate. hfNCSCs exhibit high differentiation potential, ethical acceptability, and accessibility, possessing significant advantages in axonal regeneration and functional recovery. Concurrently, small extracellular vesicles (sEVs) derived from stem cells have garnered increasing attention for their low immunogenicity, non\u2010tumorigenicity, and convenient storage. Preclinical studies highlight their synergistic potential in modulating neuroinflammation, enhancing Schwann cell (SC) activity, and promoting nerve repair. 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