Last time, we discussed the use of cybernetics in fiction, especially where they’re not always so advanced… or even welcome at all. Now let’s look at using cybernetics in D&D/TTRPGs.
In a fantasy game, like D&D, magical healing is a normal course of action. Healing potions, spells, even options for regeneration and resurrection exist. So whether your character is crushed by falling rocks (everyone dies), eaten by a dragon, or engulfed by a sorcerer’s fireball, they’re able to spring back into shape and step back into action, with nary a permanent scratch.
You might, of course, explore other options.
There may be times when massive or magical damage can heal, but leaves permanent scarring. Characters rarely keep records of their wounds, but then again, why not? We’re asked to consider a character’s backstory with great detail, but their ongoing story merits a historical record as well, measured in ways other than experience and gold.
How many times has a character been dropped to 0 hp, and recovered? Died, and returned? What toll might that take upon them in the game? When at death or near-death, did they ever meet with their deity?
Conversely, are there demons or devils eagerly awaiting their soul (and are furious each time they are thwarted and the characters is resurrected); and at what point will they enter the Prime Material Plane in order to capture their soul directly and drag it back? (This makes for dangerous NPCs—the trope of bounty hunters for souls that belong in the afterlife.)
The Mostly Dead
In earlier editions of D&D, resurrection was by no means automatic. In 1st edition, a character’s Constitution score gave their “Resurrection Survival” percentage; the “chance the character has of being successfully raised from the dead or resurrected by a cleric.” Furthermore, a character could never be returned more times than their overall Constitution score.
In addition, the 1e Dungeon Master’s Guide gave options for reaching 0 hit points (pg. 82). After every round, such a character would lose another hit point until they finally reached -10 and died. Any character brought back after falling to -6 could further “indicate scarring or the loss of some member, if you so choose.”
As DM, you might have your own system, that adds repercussions for (barely) surviving death. Characters may need to make a Constitution check, with a high roll granting no ill effects. Whereas a low roll might result in said scars or missing limbs, alignment change (owing to the psychic trauma), or even reincarnating as a completely different creature altogether.

For now, let’s consider the missing limbs aspect…
Fantasy Cybernetics
In a game involving peril to life and limb, it stands that permanent injury may occur regardless of magical healing; in which case, mechanical or magical prosthetics may come into play.
With Major Bludd, we looked at cybernetics in the context of powerful weapons; and in fiction, with consideration of their risks and drawbacks. Let’s consider these angles when it comes to D&D/TTRPGs as well:
Mechanical Prosthetics: Characters may readily seek out artificers or other expert crafters to devise prosthetics. Prosthetic limbs already exist as magic items within the Dungeon Master’s Guide, but only function in the same way as the original limb; the magic element is limited to their ability to be attached/detached at will.
Over at the Dungeon Masters Guild, however, you can find a much greater selection of house rules and further options (such as with Daria’s Guide to Prosthetics). These options explore advanced mechanics that might be developed and implemented.
“Living” Grafts: Instead of a purely mechanical option, living grafts might be magically employed. These can be from the same types of creatures as the recipient—or from different ones altogether, which might provide unique abilities, and costs, all their own.
On the magical construct side, these include limbs taken from, or designed for, warforged and golems. A golem’s limb, for example, might still require the same manual for the type of golem, as well as crafter, ritual, and materials.
And like the golem they’re from, they might have similar characteristics—a flesh golem’s arm1 might provide greater strength and gain healing from electrical damage, but also provide greater vulnerability to fire as well as the chance to go berserk when bloodied (or at least the arm going berserk, Dr. Strangelove-style).2
Other grafts might be similar. An ogre’s arm may provide added strength (akin to wearing gauntlets of ogre power) that also allows for wielding oversized weapons. A hook horror’s arm may not allow for holding any weapons, but its hook significant deals damage by itself, and has the power to magically communicate in code with other creatures through its tapping.
Magical Options: The Hand and Eye of Vecna3 are profoundly evil artifacts that require a personal sacrifice in order to use—namely, the removal of a living hand and eye from their wielder, in order to graft into place.4

Other prosthetics may offer their own magical abilities (at cost). A hand may be able to cast certain spells X times/day, such as magic missile, spider climb, or of course Bigby’s hand (and any of its variants from previous editions). The wielder may be able to safely cast the spell(s) 1/day, but each additional casting causes +1 level of Exhaustion.
Perhaps certain hands are also paired with exceptionally powerful weapons or artifacts. A fire giant’s arm might allow the wielding of uniquely powerful flametongue swords. A counterpart to the Hand of Vecna, the Hand of Kas may be required (and grafted onto an individual) to wield the Sword of Kas.
Some hands might even retain some former intelligence and personality of its original owner, even able to outwardly communicate through hand signals/sign language. Or, to auto-write messages, and provide some further avenue for the DM to provide whatever hints, clues, or challenges. But, which leads to…
Curses and Side Effects: The story potential is always there to add into any campaign, with dramatic (and perhaps secret) side effects. What if a grafted arm turns out to be lycanthropic, and transforms with the full moon? Or if it’s evil in alignment, and acts in ways counter to its new owner? The arm of a master thief might provide a bonus to picking locks, but also cannot help itself from pickpocketing as well (perhaps even without the awareness of the owner, who awakens every day with a chance to find some unknown, possibly valuable, possible dangerous, object clutched in its grip).
As noted with Dr. Strangelove (or “The Revolutionary,” from Gene Wolfe’s absolutely The Shadow of the Torturer), what if a grafted hand desires the death of its new owner?5 Perhaps by killing the owner, the hand’s original personality can take over the body. In which case, some contest of wills, a Charisma saving throw, might be required periodically, lest the hand choke their owner to death in the night.
In the original Baldur’s Gate video game, you could find a golem’s arm (and head; see footnote #3) needed to complete and reactivate an iron golem. While the item’s description says that the item is useless without a body, suggesting the need to find the rest of the golem, I’m sure I’m not the only one to think that one of my character’s bodies might be a suitable host as well.
I do love me some golems. These characteristics are essentially what I worked into the leather golem armor magic item, found in a D&D adventure I designed for Extra Life, Lost Laboratory of Kwalish.
(In hindsight, that item sure could’ve used another development pass.)
Oh yeah, that joke in the subtitle about the Head of Vecna. If you’ve never heard the story, you can even find it recounted on Vecna’s Wiki page. I later helped produce the adventure version for it as part of the D&D website’s annual April Fool’s Day content (a much beloved tradition).
I was privileged to play in an ongoing Thursday night campaign, with Bill Slavicsek as DM, along with Michelle Carter, James Wyatt, Chris Perkins, and Jeff Grubb as fellow players. I have no idea how I managed to finagle my way into that game, but I do remember once very nearly getting my hands on the Hand of Vecna, only for Michelle’s character to quickly destroy it. Probably for the best; Dr. Garret Farwhere (my character) was a bit of a troublemaker.
Hmm. I mean, “Strangelove” does resemble “Strange-glove” or even “Strangle-glove”. I came to this movie later in life, but my dad did introduce me to the physical comedy of Peter Sellers earlier through the Pink Panther films.