Skin wound healing is an intractable problem that represents an urgent clinical need. To solve this problem, a large number of studies have focused on the use of exosomes (EXOs) derived from adipose-derived stem cells (ADSCs). This review describes the mechanisms whereby ADSCs-EXOs regulate wound healing and their clinical application. In the wound, ADSCs-EXOs modulate immune responses and inflammation. They also promote angiogenesis, accelerate proliferation and re-epithelization of skin cells, and regulate collagen remodelling which inhibits scar hyperplasia. Compared with ADSCs therapeutics, ADSCs-EXOs have highly stability and are easily stored. Additionally, they are not rejected by the immune system and have a homing effect and their dosage can be easily controlled. ADSCs-EXOs can improve fat grafting and promote wound healing in patients with diabetes mellitus. They can also act as a carrier and combined scaffold for treatment, leading to scarless cutaneous repair. Overall, ADSCs-EXOs have the potential to be used in the clinic to promote wound healing.