Graphical abstract shows a summary of ADSCs mechanisms in promoting wound healing. ADSCs: Adipose-derived stem cells, CXCR-4: CXC chemokine receptor type 4, ECM: Extracellular matrix, EGF: Epithelial growth factor, FGF: Fibroblast growth factor, HUVECs: Human umbilical vein endothelial cells, Mif: Macrophage migration inhibitor factor, PDGF: Platelet-derived growth factor, PI3K: Phosphoinositide 3-Kinase, SDF-1: Stromal-derived factor-1, TGF: Transforming growth factor, VEGF: Vascular endothelial growth factor, vWF: von Willebrand factor.

With the increasing global prevalence of diabetes mellitus, a significant rise in the number of patients suffering from non-healing wounds is expected. However, available treatments, such as revascularization surgery and foot care education are often insufficient to ensure satisfactory wound healing. One therapeutic strategy that has been identified as particularly promising utilizes adipose-derived stem cells (ADSCs). Through a comprehensive literature search of published and ongoing studies, we aimed to provide an overview of the experimental basis, the scientific background, and advances in the delivery of ADSCs for treating non-healing diabetic wounds. ADSCs have the capacity to differentiate into multiple cell lineages and are considered an alternative to bone marrow–derived mesenchymal stem cells. They can be easily extracted from the adipose tissue and are capable of in-vitro expansion. The reviewed experimental studies showed that ADSCs can enhance diabetic wound healing through increasing epithelialization and granulation tissue formation, anti-inflammatory and anti-apoptotic effects, and release of angiogenic cytokines. Moreover, few small clinical trials showed that ADSCs treatment in patients with diabetic ulcers caused enhanced ulcer evolution, lower pain scores, and improved claudication walking distances with no reported complications. In conclusion, ADSCs have a promising potential in the regenerative therapy of chronic diabetic wounds. However, larger studies should confirm their efficacy and long-term safety in diabetic patients.