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Adipose\u2010derived stem cell exosomes (ADSC\u2010Exos) offer a cell\u2010free strategy because their multicomponent cargo can modulate immune responses, vascular regeneration, fibroblast activity, and epidermal repair. Mechanistic studies suggest that ADSC\u2010Exos promote macrophage immunometabolic reprogramming, restore pro\u2010angiogenic signaling, improve matrix homeostasis, and protect keratinocytes from oxidative injury. Engineering approaches and biomaterial\u2010based delivery systems may further improve local retention, controlled release, and therapeutic activity. Distinct from existing ADSC\u2010Exos reviews, this review adopts a pathology\u2010to\u2010translation framework that connects the major pathological features of diabetic wounds with ADSC\u2010Exos mechanisms, engineering strategies, delivery optimization, and clinical translation. Particular emphasis is placed on donor\u2010 and process\u2010dependent heterogeneity, potency assessment, GMP\u2010compatible manufacturing, biodistribution, long\u2010term safety, and regulation. 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