Topical wound oxygen (TWO2) proposes an option in the management of refractory nonhealing venous ulcers (RVUs). End points are proportion of ulcers healed at 12 weeks, recurrence rates, reduction in ulcer size, and time to full healing. A total of 67 patients with RVU were managed using TWO2 and 65 patients with conventional compression dressings (CCDs) for 12 weeks or till full healing. Mean reduction in ulcer surface area at 12 weeks was 96% in patients managed with TWO2 and 61% in patients managed with CCD. At 12 weeks, 76% of the TWO2-managed ulcers had completely healed, compared to 46% of the CCD-managed ulcers (P < .0001). Median time to full healing was 57 days in patients managed with TWO2 and 107 days in patients managed with CCD (P < .0001). After 36 months follow-up, 14 of the 30 healed CCD ulcers showed recurrence compared to 3 of the 51 TWO2-healed ulcers. The TWO2 is effective and valuable in managing RVU. The TWO2 slashes the time required for RVU healing and radically decreases the recurrence rates.