Extracellular vesicles (EVs) are cell-derived, membrane-bound nanoparticles that carry a diverse array of molecular cargo. Due to high biocompatibility, low immunogenicity, and cargo functionality, EVs have gained increasing recognition as promising therapeutic agents for treating a variety of diseases. To unlock the full potential of EV-based therapeutics, significant advancements have been made in EV production, isolation, cargo loading, and surface modification with progress occurring across laboratory, industrial, and clinical settings. Microfluidics has emerged as a powerful technology in recent years to enhance EV research by enabling precise control over these processes. In this review, we highlight recent advancements in microfluidic-assisted EV release, isolation, cargo recruitment, and target selectivity with the goal of optimizing EV-based drug delivery. We provide an overview of chip-mediated EV processing methods, exploring techniques that utilize mechanics, electricity, hydrodynamics, acoustics, and other innovative approaches to enhance the efficiency of EVs for drug administration. We additionally discuss the current challenges and limitations in applying microfluidic systems to EV therapeutic research. Overcoming these obstacles in future through innovative microfluidic strategies is crucial for advancing the field and ultimately enhancing EV-based drug delivery systems for the treatment of various diseases.