Biofabricated tissue scaffolds incorporating drug-loaded microchannels represent a promising advancement in regenerative medicine. These constructs aim to address the limitations of conventional tissue engineering approaches by integrating therapeutic functionalities within the scaffold matrix. The incorporation of microchannels enables precise control over the spatial and temporal release of therapeutic agents, enhancing local tissue regeneration while minimizing systemic side effects. Key considerations in the design include material biocompatibility, mechanical properties, and the bioactive properties of the loaded drugs. Recent developments have focused on optimizing fabrication techniques such as 3D bioprinting and microfluidics to achieve reproducible and customizable scaffold architectures. This review explores the current state-of-the-art in biofabricated tissue scaffolds with drug-loaded microchannels, highlighting their potential applications in diverse clinical scenarios including wound healing, bone regeneration, and organ repair. Future directions involve further refinement of scaffold design, comprehensive preclinical evaluation, and translation to clinical settings to realize their full therapeutic potential in regenerative medicine.