Stem cell-derived small extracellular vesicles (sEVs) have shown tremendous potential in regenerative medicine in recent years. These sEVs exert multiple therapeutic effects comparable or superior to their parental stem cells while avoiding the limitations of stem cell-based therapy. The two routine modalities of sEV administration are systemic injection and local delivery. Various biomaterials are developed to assist their local delivery to improve the targeting of organs, minimize nonspecific accumulation in vital organs, and ensure the protection and release of sEVs. This comprehensive, up-to-date, specialty-specific, disease-oriented, and preclinical review is presented to expound on the surgical application and potential of stem cell-derived sEVs. The local delivery of stem cell-derived sEVscan treat numerous diseases encountered in orthopedic surgery, neurosurgery, plastic surgery, cardiothoracic surgery, general surgery, urology, otorhinolaryngology, ophthalmology, obstetrics and gynecology, and dental surgery. In addition, the biomaterials utilized encompass a wide range of sources (e.g., natural, synthetic, and hybrid polymers), format (e.g., scaffold, patch, spray, microneedle), and responsiveness (e.g., temperature, pH, and protein), which enables customized sEV therapy tailored to specific diseases. This review demonstrates biomaterial-facilitated local delivery of stem cell-derived sEVs as a viable alternative or even a superior option to systemic sEV therapy.

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生物材料促进干细胞衍生的小细胞外囊泡的局部递送：手术治疗的前景

近年来，干细胞衍生的小细胞外囊泡（sEV）在再生医学中显示出巨大的潜力。这些 sEV 具有与其亲本干细胞相当或优于其亲本干细胞的多种治疗效果，同时避免了基于干细胞的治疗的局限性。 sEV 给药的两种常规方式是全身注射和局部递送。人们开发了各种生物材料来协助其局部递送，以提高器官的靶向性，最大限度地减少重要器官中的非特异性积累，并确保 sEV 的保护和释放。这篇全面、最新、针对特定专业、以疾病为导向的临床前综述旨在阐述干细胞衍生 sEV 的外科应用和潜力。干细胞衍生的 sEVscan 的局部递送可治疗骨科手术、神经外科、整形外科、心胸外科、普外科、泌尿科、耳鼻喉科、眼科、妇产科和牙科手术中遇到的多种疾病。此外，所使用的生物材料涵盖广泛的来源（例如天然、合成和混合聚合物）、形式（例如支架、贴片、喷雾、微针）和响应性（例如温度、pH和蛋白质），这使得针对特定疾病的定制 sEV 治疗成为可能。本综述表明，生物材料促进干细胞衍生 sEV 的局部递送是一种可行的替代方案，甚至是系统 sEV 治疗的更好选择。