The study evaluated the efficacy of vastus lateralis musculocutaneous flap transplantation (VLMCF) combined with ultrasound-mediated transdermal administration of Qianjin Weijing decoction in patients with chronic empyema. In a prospective observational study from July 2023 to June 2025, 114 patients were included, with 57 receiving combined therapy and 57 only surgery. At 2 weeks, the combination group showed a significantly greater reduction in cavity volume (20.52 ± 4.45 mL vs. 24.40 ± 6.35 mL; adjusted difference -5 mL, p=0.005). After 3 months, cavity volumes were comparable in both groups. Combination therapy resulted in significantly lower procalcitonin levels at 3 months (adjusted difference -0.10, p=0.0005). No significant differences were found in albumin, hemoglobin, CRP, WBC or quality of life (SF-36) after correction. The authors conclude that adding the decoction accelerates early cavity healing and improves procalcitonin, but randomized trials are needed to confirm.