Stem cell-derived exosomes offer a promising alternative to stem cell-based therapy due to their non-immunogenicity, ease of use, and reduced risk of tumorigenicity. They can inherit therapeutic effects from their parent cells, such as anti-inflammatory and tissue-regenerative properties. This review highlights their potential in various surgical fields, including orthopedic, neurosurgical, and trauma surgery. Exosomes from different stem cell types, such as mesenchymal, neural, and endothelial stem cells, have shown efficacy in treating conditions like fractures, osteoarthritis, spinal cord injuries, and muscle/tendon tears. They are also being explored for neurosurgical applications, such as ischemic stroke and traumatic brain injury, where they can promote neurogenesis, reduce inflammation, and protect neurons. Exosome therapy is being optimized through methods like modification, loading with therapeutic agents, and surface engineering to enhance their targeting and therapeutic effects. Challenges remain in exosome production, purification, and clinical translation, but ongoing research suggests that exosomes could become a versatile and effective treatment option for a wide range of diseases and surgical conditions.Stem cell-derived exosomes offer a promising alternative to stem cell-based therapy due to their non-immunogenicity, ease of use, and reduced risk of tumorigenicity. They can inherit therapeutic effects from their parent cells, such as anti-inflammatory and tissue-regenerative properties. This review highlights their potential in various surgical fields, including orthopedic, neurosurgical, and trauma surgery. Exosomes from different stem cell types, such as mesenchymal, neural, and endothelial stem cells, have shown efficacy in treating conditions like fractures, osteoarthritis, spinal cord injuries, and muscle/tendon tears. They are also being explored for neurosurgical applications, such as ischemic stroke and traumatic brain injury, where they can promote neurogenesis, reduce inflammation, and protect neurons. Exosome therapy is being optimized through methods like modification, loading with therapeutic agents, and surface engineering to enhance their targeting and therapeutic effects. Challenges remain in exosome production, purification, and clinical translation, but ongoing research suggests that exosomes could become a versatile and effective treatment option for a wide range of diseases and surgical conditions.