Purpose: The supraclavicular artery island (SAI) flap is commonly used in the reconstruction of head and neck defects. However, the safety of SAI flaps for neck irradiated patient needs to be verified. To investigate the safety of using the SAI flap for patients who have undergone neck radiotherapy, as well as the risk factors for flap complications. Materials and Methods: Sixty-one patients (16 irradiated and 45 nonirradiated) with SAI flap-reconstructed head and neck defects were included, and relevant data were collected retrospectively. The gender, age, body mass index, presence of diabetes mellitus, preoperative albumin level, and flap size between irradiated and nonirradiated patients had no significant difference. Results: No significant difference was observed in the incidence of complications (total, mild, or severe) between the radiotherapy and nonradiotherapy groups. In univariate analysis, preoperative radiotherapy was not associated with postoperative complications of the SAI flap procedure (P = 1.00), while a low preoperative albumin level was a significant risk factor for postoperative complications (P < .05). Conclusions: Our data suggest that preoperative radiotherapy does not increase the risk of SAI flap postoperative complications compared with surgical reconstruction alone.