Objective To review the recent advances in the application of exosome-hydrogel system for wound healing. Methods A wide range of recent domestic and international studies were reviewed to systematically outline the roles and mechanisms of exosomes, hydrogels, and their composite system in promoting wound repair. Results Wound healing is a complex and finely regulated process. Traditional therapies lack targeted regulation of key mechanisms such as inflammation control, angiogenesis, collagen remodeling, and re-epithelialization. The exosome-hydrogel system enhances wound repair through targeted modulation of these mechanisms and provides effective protection against bacterial infection, hypoxia, excessive oxidative stress, and hyperglycemic microenvironments. Conclusion The exosome–hydrogel system represents an emerging approach for chronic wound repair and skin regeneration, potentially overcoming the inherent limitations of traditional therapies. Nevertheless, the lack of standardized preparation methods and dosing protocols calls for further optimization.