Skin injury repair is a complex biological process, and research aimed at enhancing the self-repairing capacity of chronic or refractory skin wounds has significant clinical relevance. Exosomes, a subset of extracellular vesicles secreted by cells, have emerged as critical mediators of intercellular communication. Among these, stem cell-derived exosomes exhibit multifaceted biological functions, including the modulation of immune and inflammatory responses, promotion of angiogenesis at wound sites, acceleration of skin cell proliferation and re-epithelialization, and inhibition of excessive scar formation. These properties position stem cell-derived exosomes as a promising therapeutic strategy in the field of skin injury repair. This review comprehensively examines the regulatory roles and molecular mechanisms underlying the actions of stem cell-derived exosomes during skin injury repair. It further summarizes their emerging clinical applications in the treatment of chronic or refractory skin wounds, while exploring potential future directions for research and development in this rapidly evolving field.