Extracellular vesicles (EVs) are membrane-like structures secreted by cells that play a crucial role in intercellular communication and molecular transfer. Recent studies have shown that EVs from specific sources can regulate tissue repair and regeneration by delivering proteins, lipids, and nucleic acids to target cells as signaling molecules. Advances in nanotechnology have enabled the development of engineered EVs for tissue repair, with enhancements through gene editing, surface modification, and content modification improving their therapeutic efficacy. This review summarizes the potential of EVs in tissue repair and regeneration, their mechanisms of action, and their research progress in regenerative medicine. It highlights their design logic through typical examples and explores the development prospects of EVs in tissue repair. The aim of this review is to provide new insights into the design of EVs for tissue repair and regeneration applications, thereby expanding their use in regenerative medicine. EVs are categorized into three types based on their biogenesis: exosomes, microvesicles, and apoptotic bodies. Exosomes, ranging from 30 to 150 nm in size, originate from the invagination of the plasma membrane. Microvesicles, which measure between 100 and 1000 nm, are primarily released by platelets and endothelial cells. Apoptotic bodies, which range from 50 to 5000 nm in size, are released during programmed cell death. EVs play critical roles in various biological processes, including intercellular communication, gene expression regulation, reproduction, cell development and proliferation, wound healing, metabolic regulation and reprogramming, signaling, immune response, apoptosis, and the progression of cancer. EVs have recently gained prominence as crucial intermediaries for intercellular information transfer and as vehicles for drug delivery across various biological systems. Research has shown that EVs can selectively transport specific genetic cargo and target particular cell types through relatively straightforward methods. EVs also play a vital role in fundamental biological processes by influencing pleiotropic functions. They achieve this through multiple mechanisms: directly activating cell surface receptors via proteins and bioactive lipid ligands, integrating their membrane contents into the plasma membrane of recipient cells, and delivering effectors such as transcription factors, oncogenes, small and large noncoding regulatory RNAs (including miRNAs), messenger RNAs (mRNAs), and even infectious particles. EVs have emerged as key players in tissue repair, demonstrating their ability to accelerate wound hemostasis, modulate macrophage polarization toward an anti-inflammatory state, stimulate the proliferation and migration of vascular endothelial cells and fibroblasts, regulate cytokine ratios, and remodel the ECM to facilitate tissue repair. EVs derived from MSCs have shown significant procoagulant effects on human blood and platelet-free plasma, underscoring their potential in wound healing. MSC-EVs have also been implicated in reducing inflammation, particularly in hyperglycemic environments, by mitigating oxidative stressExtracellular vesicles (EVs) are membrane-like structures secreted by cells that play a crucial role in intercellular communication and molecular transfer. Recent studies have shown that EVs from specific sources can regulate tissue repair and regeneration by delivering proteins, lipids, and nucleic acids to target cells as signaling molecules. Advances in nanotechnology have enabled the development of engineered EVs for tissue repair, with enhancements through gene editing, surface modification, and content modification improving their therapeutic efficacy. This review summarizes the potential of EVs in tissue repair and regeneration, their mechanisms of action, and their research progress in regenerative medicine. It highlights their design logic through typical examples and explores the development prospects of EVs in tissue repair. The aim of this review is to provide new insights into the design of EVs for tissue repair and regeneration applications, thereby expanding their use in regenerative medicine. EVs are categorized into three types based on their biogenesis: exosomes, microvesicles, and apoptotic bodies. Exosomes, ranging from 30 to 150 nm in size, originate from the invagination of the plasma membrane. Microvesicles, which measure between 100 and 1000 nm, are primarily released by platelets and endothelial cells. Apoptotic bodies, which range from 50 to 5000 nm in size, are released during programmed cell death. EVs play critical roles in various biological processes, including intercellular communication, gene expression regulation, reproduction, cell development and proliferation, wound healing, metabolic regulation and reprogramming, signaling, immune response, apoptosis, and the progression of cancer. EVs have recently gained prominence as crucial intermediaries for intercellular information transfer and as vehicles for drug delivery across various biological systems. Research has shown that EVs can selectively transport specific genetic cargo and target particular cell types through relatively straightforward methods. EVs also play a vital role in fundamental biological processes by influencing pleiotropic functions. They achieve this through multiple mechanisms: directly activating cell surface receptors via proteins and bioactive lipid ligands, integrating their membrane contents into the plasma membrane of recipient cells, and delivering effectors such as transcription factors, oncogenes, small and large noncoding regulatory RNAs (including miRNAs), messenger RNAs (mRNAs), and even infectious particles. EVs have emerged as key players in tissue repair, demonstrating their ability to accelerate wound hemostasis, modulate macrophage polarization toward an anti-inflammatory state, stimulate the proliferation and migration of vascular endothelial cells and fibroblasts, regulate cytokine ratios, and remodel the ECM to facilitate tissue repair. EVs derived from MSCs have shown significant procoagulant effects on human blood and platelet-free plasma, underscoring their potential in wound healing. MSC-EVs have also been implicated in reducing inflammation, particularly in hyperglycemic environments, by mitigating oxidative stress