Central neck exenteration with an anterior soft tissue defect and short tracheal remnant after resection of tracheostomal recurrence is a reconstructive challenge. A free jejunum transfer is the preferred option for pharyngeal reconstruction. However, an additional flap, usually a deltopectoral or pectoral flap is needed to provide thin, pliable tissue for peristomal reconstruction. In this case of a 72 year-old female undergoing neck exenteration for recurrent carcinoma at her tracheostomy a free jejunum transfer was performed. The transferred jejunum was divided into two segments sharing a common pedicle; an alimentary segment for hypopharyngeal reconstruction, and a peristomal segment, which was split open, demucosalized, inset into the soft tissue defect, contoured to the tracheal remnant, and skin-grafted. The reconstruction was stable, well contoured, without bulk or airway compromise, and with 100% skin graft take. Skin-grafted demucosalized jejunum provides excellent characteristics for reconstruction of the anterior neck and tracheostoma: it is thin, pliable, with good tensile strength, contours well to the neck, provides stable lining, and allows for postoperative monitoring of flap perfusion. Compared to traditionally used flaps, demucosalized jejunum in the setting of free jejunal transfer offers superior characteristics and avoids a second flap with its attendant morbidity.