West Ham midfielder Mark Noble has been ruled out of England Under 21s' qualifying double-header with Bulgaria and Portugal.
Noble, who has scored in two of England's wins in their Euro 2009 campaign so far, needs a double hernia operation.
The highly-rated midfielder has travelled to Germany to see Dr Ulrike Muschaweck, who has recently treated Michael Owen and Craig Bellamy.
Portsmouth defender Martin Cranie is also missing after breaking his leg while on loan at QPR.
Manchester City ace Michael Johnson, who missed the wins over Montenegro and Republic of Ireland, is absent again with his groin complaint.
Sunderland's Grant Leadbitter has earned a call-up, while James Vaughan is back in the squad after recovering from a dislocated shoulder.
Under 21 boss Stuart Pearce admits he has been impressed by Leadbitter this season.
"Grant's played in one or two positions for Sunderland this season and has done very well," Pearce said.
"I went into Sunderland a couple of weeks ago and watched them train, and also saw him play against Manchester City.
"He's playing regularly and getting Premier League experience and I think he deserves his chance in the squad."
Pearce added: "We've got some absentees with Mark Noble, Michael Johnson and Martin Cranie all out, but have been able to bring in some new players who have been looking good this season.
"It's the first time back in for James Vaughan since the summer and he's been very unlucky with injuries otherwise he would have been in the other squads this season.
"But it's good to see him back in contention, especially after a goal for Everton on Saturday."
England will face Bulgaria at stadium:mk on 16th November and travel to Portugal the following Tuesday, by which time they could have virtually secured a place in the play-offs to reach the finals in Sweden.