In Dungeons & Dragons a mutilation is when a character takes extreme amounts of damage that might result in losing an arm, leg, eyeball, finger, toe or any other kind of appendage.  There are multiple ways to become mutilated and such injuries are normally permanent.  Some mutilations may be so extreme that a character is forced to retire from the adventuring life altogether, while some may be relatively minor. Below are the ways in which a player can become mutilated.

Combat mutilations:

1. Critical strikes that reduce HP to zero result in a mutilation.
2. Taking substantial damage while at zero HP results in a mutilation.
3. Taking your maximum health in damage from a single attack results in a mutilation.

The rules:

If a player gets mutilated roll a d6 to determine which part of his body will be targeted. Roll an additional d6 to determine the mutilation.  All mutilations will result in either minor or major bleeding as well as a degree of exhaustion.  Minor bleeding = 1d4 damage each turn for 3 turns or until the wound is healed. Major bleeding = 1d6 damage each turn for 4 turns or until healed. If a player is at zero HP any bleeding instead causes one point of exhaustion.

(1)  Head:

A mutilation to the head will cause a minor, aching concussion that results in disadvantage on all wisdom, intelligence and charisma checks until healed.

1 - Eye
Your eye is pulverized inside of its socket, sending the fluid within spraying out from your head.  Roll a 1d4.  (1)Your eye turns pale blue.  (2) Your eye turns blood red.  (3-4). Your eye is completely destroyed. Minor bleeding. 1 Exhaustion.
2 - Ear
Your ear is severed.  Roll 1d4. (1)The top half of your ear is ripped off.  (2)The bottom half of your ear is ripped off.  (3-4) Your entire ear is ripped off.  Minor bleeding. 1 Exhaustion.
3 - Mouth
A viscous blow to the mouth tears your lip asunder.  The force of the impact rips 3d6 teeth from your gums and launches them into the back of your throat.  Minor Bleeding. 1 Exhaustion.
4 - Nose
A devastating force dismembers the center of your face, ripping the cartilage from your nose.  Minor bleeding. 1 Exhaustion.
5 - Jaw
A brutal attack strikes you across the jaw causing it to shatter and hammer down against your teeth.  Lose 2d4 teeth.  Roll 1d4.  (1)You have an underbite.  (2)You have an overbite. (3-4)Your jaw is crooked. Minor bleeding. 1 Exhaustion.
6 - Horrible Wound
Roll a d4.  (1)A single deep gash cuts across one eye vertically.  (2)A deep gash travels beneath both eyes and over the nose horizontally.  (3)A deep gash cuts verticly from center cheek and across the lips.  (4) At least half of your face is covered in deep, scarring wounds. Major bleeding.  Will leave scars. 2 Exhaustion. 

(2)  Arm:

A mutilated arm will cause disadvantage on all strength checks until the arm is healed, replaced or substituted.

1 - Shoulder
A devastating force tears down from your shoulder, streaking across the entire length of your arm and severing the flesh from your bone entirely. Major bleeding. 1 Exhaustion.
2 - Fingers
A mighty blow crashes down across your fingers sending a jolt of excruciating pain up the entirety of your arm.  Roll 1d4 to determine how many are destroyed.  As long as you have 2 fingers you can still hold most things without penalty. Minor Bleeding. 1 Exhaustion.
3 - Hand
A violent force rips at the joint between your hand and forearm, severing your hand entirely.   Major Bleeding. 1 Exhaustion.
4 - Elbow
A viscous attack severs your arm at the elbow, leaving you with nothing but a bloody stump.  You can no longer grip anything because you don’t have an arm.  Major Bleeding. 1 Exhaustion.
5 - Bone
Your arm is crushed causing all of the bones in your arm to shatter like gorey dominoes and splinter outward from your flesh.  Major Bleeding. 1 Exhaustion.
6 - Horrible wound
Roll 1d4.  (1)A series of deep lacerations streak across your bicep.  (2)Multiple deep wounds run downward from your elbow, continuing across the back of your hand.  (3) A deep wound slopes across your neck, collar bone and upper bicep.  (4) Your entire arm is bloody and mangled.  Major bleeding.  Will leave scars. 2 Exhaustion. 

(3)  Torso:

A mutilation of the torso will damage your respiratory and circulatory systems, disallowing proper oxygen and blood flow to the brain.  This will result in disadvantage on constitution, wisdom, intelligence and charisma checks until healed.

1 - Rib Cage
A heavy strike tears through your flesh and crushes the bone beneath, causing you to get knocked back 10 feet in the air.  You break 2d6 ribs. Major bleeding. 2 Exhaustion. 
2 - Lung
A centralized strike manages to shatter multiple ribs in the direction of your lung, causing it to be sliced open and bleed internally.  Break 1d4 ribs and one of your lungs collapses. 2 Exhaustion. 
3 - Collar bone
A 6 inch deep wound slopes across your collar bone toward your arm, nearly splitting your arm from your torso.  Major bleeding. 2 Exhaustion.  
4 - Throat
Your throat is crushed, severing your vocal chords and leaving your wheezing for air.  Major bleeding. 2 Exhaustion. 
5 - Heart
A tremendous force crashes down on your chest and put an enormous pressure on your heart, potentially exploding it.  Instantly reduces you to 0 hitpoints with two failed death saves.  If you are already at zero HP you will instantly die. 3 Exhaustion. 
6 - Horrible wound
Roll 1d4. (1)Your pectoral muscles are torn from your chest along with any flesh atop them. (2)Two deep wounds form an X across your chest.  (3) A series of deep wounds run vertically down your chest.  (4) A series of deep wounds travel horizontally across your chest.  Major bleeding.  Will leave scars. 2 Exhaustion.

(4)  Abdomen:

A mutilation of the abdomen causes damage to your vitals, resulting in disadvantage on constitution checks.

1 - Disembowelment
In a gruesome display your intestines are pulled out of your stomach and left dangling to your knees.  Major bleeding.  2 Exhaustion. 
2 - Organs
roll 1d4 to determine which organ is destroyed.  (1)Bladder – Everytime you drink anything suffer 1d4 damage.  You will frequently pee yourself, (2)Spleen – Diseases are twice as effective against you, (3)Liver – You can no longer process poison or alcohol and the effect of poisonous substances are doubled, (4)Stomach – Everytime you eat food suffer 1d6 damage and vomit it back up if you roll a (1) on a 1d4.  Major bleeding. 1 Exhaustion.
3 - Castration
A paralyzing pain engulfs your body as your genitals are mutilated beyond repair.  You will have trouble urinating or making love. Major bleeding. -5 confidence. 1 Exhaustion.
4 - Aorta
A devastating wound splits you open and severs your aorta artery, causing you to suffer extreme bleeding.  You will die if not treated within four turns. Major bleeding. 1 Exhaustion per turn bleeding.
5 - Stomach
 A brutal attack tears open your mid-region and causes the contents of your stomach to spill out, leaving your stomach completely destroyed.   You will die if not treated within four turns. Major Bleeding. 1 Exhaustion per turn bleeding.
6 - Horrible wound
Roll 1d4.  (1)Two deep wounds form an X across your abdomen.  (2)3 deep wounds cut vertically across your abdomen.  (4) A series of deep wounds cut horizontally across your abdomen,  (4) Your abdomen is covered in lacerations. Major bleeding.  Will leave scars. 2 Exhaustion.

(5)  Spine

A mutilation of the spine will damage your nervous system, causing disadvantage on all constitution, dexterity and strength checks.

1 - Neck
A decisive blow collides with your neck causing your spine to snap right below the base of your skull.  Minor bleeding. 2 exhaustion 
2 - Ribs
A tremendous force crushes 2d6 ribs and causes the bone to splinter like shrapnel through your body.  Major Bleeding. 2 exhaustion
3 - Sodomization
Whether by purpose or accident, your rectal cavity is pierced with a rigid, painful object.  Major bleeding. 1 exhaustion
4 - Tailbone
A crushing blow shatters your spine right above your pelvis sending a wave of horrendous pain up your spine.  Minor bleeding. 1 exhaustion
5 - Pelvis
A gargantuan weight pulverizes your pelvis causing it to shatter beyond repair.  Minor bleeding.
6 - Horrible wound
Roll 1d4.  (1)Two deep wounds form an X across your back.  (2)3 deep wounds cut vertically across your back.  (4) A series of deep wounds cut horizontally across your back,  (4) Your back is covered in lacerations. Major bleeding.  Will leave scars. 2 Exhaustion.

(6)  Leg:

A mutilated leg will cause disadvantage on all dexterity checks until the leg is healed, replaced or substituted.

1 - Groin
A mighty attack cuts through the thick of your thigh and separates your leg from your body.  Your leg is severed at the groin.  Major bleeding, 2 exhaustion.
2 - Toes
A mighty blow crashes down across atop your foot sending a jolt of excruciating pain up the entirety of your arm.  Roll 1d4 to determine how many toes are destroyed.  You can still walk normally unless you lose up to 4 toes on either foot.  Minor bleeding. 1 exhaustion. 
3 - Foot
A violent force rips at the base of your calf and severe your foot entirely Major bleeding. 1 exhaustion. 
4 - Knee
A furious strike crashes against your knee, tearing through the flesh and severing your leg at the joint. Major bleeding. 1 exhaustion. 
5 - Tendon
A precise impact tears at your Achilles tendon, causing a shooting paint to grip your body every time you take a step.  Minor bleeding. 1 exhaustion. 
6 - Horrible wound
Roll 1d4.  (1)A series of deep lacerations streak across your thigh.  (2)Multiple deep wounds run downward from your knee, continuing across the top of your foot.  (3) A deep wound slopes across your pelvis right above your groin and ends at your thigh.  (4) Your entire leg is bloody and mangled. Major bleeding.  Will leave scars.

Additional rules: No injury has to be permanent.  A lost arm could be replaced by an enchanted phantasmal arm, an ooze arm or transplanted with another creature’s arm.  Perhaps there might be magic great enough to cure the wound entirely.  There are many creative ways to compensate for or regenerate lost parts completely, bionic or organic prosthetics included.  A skeleton arm could be reanimated by a wizard to be fully functional.  These things should come at a cost, but use your imagination.

Some wounds might come with certain benefits.  It is up to the DM to keep them balanced.  Remember: most players would rather re-roll than play a gimped character for the rest fo the campaign.  However, sometimes an extreme wound could be the equivalent of death if you are an adventurer.  Time to retire and open up a tavern on the countryside.  Enjoy!


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