Role of exosome therapy in reconstructive surgery: a review

Introduction: Exosomes are nanosized extracellular vesicles that facilitate intercellular communication through their diverse molecular cargo, including proteins, microRNAs, and lipids. By modulating inflammation, angiogenesis, and extracellular matrix remodeling, exosomes have emerged as promising therapeutic agents in plastic and reconstructive surgery. Understanding source-specific characteristics, isolation methods, and delivery strategies is crucial to optimize their clinical translation. Methods: This review employed a review approach, integrating preclinical and clinical evidence to provide a comprehensive overview of exosome biology, sources, isolation techniques, delivery modalities, and therapeutic applications. Emphasis was placed on highlighting mechanistic insights, translational relevance, and comparative analyses of different exosome sources and delivery strategies. The methodology prioritized thematic organization and qualitative integration over quantitative meta-analysis to capture the breadth of current knowledge and emerging trends in regenerative and reconstructive surgery. Results: Adipose-derived stem cell (ADSC) exosomes provided high yields with strong angiogenic and anti-fibrotic effects, whereas bone marrow MSC (BM-MSC) and dermal fibroblast exosomes primarily contributed immunomodulatory and extracellular matrix regulatory functions. Umbilical cord MSC (UC-MSC) exosomes showed high proliferative and angiogenic potential. Delivery methods, including topical, hydrogel-based, and direct injection approaches, influenced therapeutic outcomes. Preclinical and early-phase clinical studies reported improved wound closure, scar modulation, and aesthetic outcomes, though the clinical evidence remains predominantly derived from small pilot studies and exploratory trials with limited sample sizes and follow-up durations. Variability in isolation protocols, dosing, and characterization further limited standardization. Discussion: Exosome-based therapy represents a versatile, minimally immunogenic regenerative approach. Standardized source selection, scalable GMP-compliant isolation, and optimized delivery are essential for reproducibility and clinical translation. Adequately powered randomized controlled trials with long-term follow-up are required to confirm efficacy and establish standardized dosing protocols.