Ischemia is a significant factor affecting the repair of peripheral nerve injuries, while exosomes have been shown to promote angiogenesis. To further investigate the detailed processes and efficacy of exosome therapy for ischemic peripheral nerve injuries, this study utilized glucose-modified near-infrared-II (NIR-II) quantum dots (QDs) to label adipose-derived stem cell exosomes (QDs-ADSC-Exos), enabling long-term in vivo NIR-II imaging of exosome treatment for ischemic peripheral nerve damage. Experimental results confirmed that QDs can be used for non-invasive in vitro labeling of exosomes, with QDs-ADSC-Exos exhibiting strong fluorescence signals in the NIR-II window and demonstrating favorable NIR-II imaging characteristics in vivo. Notably, QDs-ADSC-Exos showed accumulation at the site of nerve injury in cases of ischemic peripheral nerve damage. Functional neurological assessments indicated that QDs-ADSC-Exos effectively promoted neural regeneration. This study highlights the potential of exosomes in treating ischemic peripheral nerve injuries and elucidates the spatiotemporal characteristics of exosome therapy, providing objective evidence for the further optimization of exosome-based treatment protocols.