MILAN (AP) — The sight of Napoli winger Lorenzo Insigne being brought on for the final 15 minutes of Italy's World Cup playoff in Sweden was a welcome one for away fans.

With Italy trailing 1-0 in the first leg, the Azzurri desperately needed the creative skills of the 26-year-old Insigne.

But fans and even the Italy players themselves were bemused when Insigne took up Marco Verratti's central midfield role.

Insigne had to explain to his teammates, saying "in the middle" before shrugging his shoulders with resignation and responding "yes" to their incredulity.

The substitution failed to change the score and Italy was left at serious risk of failing to qualify for the World Cup for the first time in six decades.

"The coach knows what kind of player I am, and when I'm called upon I always try to give my best," Insigne said. "I'm sorry I wasn't able to make a difference tonight. If the coach asks me to play for one minute or 90, I'll always try to give 100 per cent.

"The coach asked if I felt ready to replace Verratti and I said yes because we have to give 100 per cent in any role the coach asks us to play, and even more with the national jersey ... I'm disappointed, but now we must get our heads down and work because we have the return match Monday and we have to try to win it at all costs."

It is this creative midfield role that will be Italy coach Gian Piero Ventura's biggest headache as he ponders what changes to ring for the second leg in Milan on Monday.

Verratti is suspended after picking up a second booking in Sweden. Jorginho has been in fantastic form for Napoli this season and seems the most natural replacement but he has never played for Italy before. However, the only other option is Roberto Gagliardini and the Inter Milan midfielder lacks the offensive capabilities needed this time round.

Italy was too predictable and slow to punish Sweden's well-organized defense on Friday. Although Ventura shelved his unpopular 4-2-4 formation, the 3-5-2 system didn't work either.

The players appear perfectly suited to a 4-3-3 system used by Napoli and Roma, who are playing the best football in Italy at the moment.

Ventura will have better options up front for the return match. Simone Zaza should be back from the knee injury which kept him out of Friday's match, while Andrea Belotti — who has only just returned from injury — will also be in better shape.

Matteo Darmian was Italy's best player on Friday and should start again at San Siro.

The veteran "BBC" defense of Leonardo Bonucci, Andrea Barzagli and Giorgio Chiellini also proved solid. Italy goalkeeper Gianluigi Buffon was rarely tested and the only goal was deflected in off Daniele De Rossi.

Buffon has called for Italy to play with more ferocity in Milan.

"We'll need a physical Italy side," the Italy captain said. "But a physical match will not be enough: we have to keep our balance, conceding a goal would be disastrous.

"We can talk about our mistakes but it won't help anything. We need to hold our heads high and stand tall to come back. We need to be fierce, us and the whole San Siro."