England full-back Josh Lewsey has been ruled out of Saturday's Six Nations tie against Italy with a shoulder injury.
Lewsey injured his left shoulder and only played 20 minutes on Saturday
The Wasps star, who will miss his first England game since the 2003 World Cup, sustained the injury during last weekend's 47-13 win over Wales.
Wing Tom Varndell and centre Stuart Abbott have been drafted into the squad but Tom Voyce is likely to start.
Bristol scrum-half Shaun Perry has also been called up, replacing Peter Richards who has a shoulder injury.
And Sale flanker Magnus Lund and Perpignan prop Perry Freshwater have been added to the 31-man squad, with the team to face Italy to be announced at 1400 GMT on Tuesday.
Winger Mark Cueto suffered bruising to his lower back, but is available to coach Andy Robinson, who names his side to play Italy on Tuesday afternoon.
Voyce, Lewsey's Wasps colleague, impressed Robinson with a try-scoring performance off the bench on Saturday and could now make his first Six Nations start for England.
But England are unlikely to make many other changes for the trip to Rome - a fact confirmed by Robinson.
"Apart from the injury we've got with Josh, I'm not really going to make any changes," said Robinson.
"We must focus on beating Italy because everything will be wasted if we don't put another big performance in. Rome is a tough place to go and Italy are always hard to play against.
"What was pleasing against Wales was the finishing of Mark Cueto for the first try, the superb Mike Tindall try that involved everybody and also the last try from Tom Voyce which went through a number of phases.
"That was the way we wanted to play. We wanted to move the Welsh forwards around. We knew that the Welsh liked to attack but didn't like to defend so if we moved the ball around spaces would open up."
Lewsey, an ever-present in all 20 Tests since the World Cup, damaged his shoulder in the first minute of England's victory at Twickenham.
He continued playing for 20 minutes but finally conceded defeat when he could no longer lift his arm.
A scan on his acromioclavicular (AC) shoulder joint - which connects the collar bone to the shoulder - on Monday showed no evidence of lasting damage.
"Reassuringly the scan did not show any structural damage but he will not be available for selection for Saturday," added Robinson.
"It is unfortunate for Josh, England and London Wasps and we wish him a quick recovery."
Backs: Tom Voyce (Wasps), Mark Cueto (Sale), Ben Cohen (Northampton), Tom Varndell (Leicester), James Simpson-Daniel (Gloucester), Mike Tindall (Gloucester), Jamie Noon (Newcastle), Stuart Abbott (Wasps), Charlie Hodgson (Sale), Andy Goode (Leicester), Matt Dawson (Wasps), Harry Ellis (Leicester), Shaun Perry (Bristol).
Forwards: Steve Thompson (Northampton), Lee Mears (Bath), George Chuter (Leicester), Andrew Sheridan (Sale), Julian White (Leicester), Matt Stevens (Bath), Perry Freshwater (Perpignan), Danny Grewcock (Bath), Steve Borthwick (Bath), Simon Shaw (Wasps), Alex Brown (Gloucester), Martin Corry (Leicester, capt), Lawrence Dallaglio (Wasps), Joe Worsley (Wasps), Chris Jones (Sale), Lewis Moody (Leicester), Magnus Lund (Sale), James Forrester (Gloucester).