Pulled out of one of my comments lower down:
I’ve been collecting ideas for “worse outcomes, hard choices” for melee:
• Opponent shoulders past to threaten someone vulnerable
• Character is pushed into dangerous terrain: off ledge, down stairs, into fire [note “forceful” tag means this happens in addition to dealing damage, but any opponent might push or trip as an attack]
• Armor or weapon is damaged or destroyed
• Are they carrying anything dangerous or valuable? Poisonous, flammable, or breakable? Was that a good idea?
• Deal damage from an ignored threat; e.g. a fighter is being threatened by three lizardmen with spears. If she just rolls to cream one of them, that’s a golden opportunity for one of the others to run her through.
• Helmet stops the blow, but bell is rung, clock is cleaned; take -1 forward
• Inflict a debility, particularly stunned, confused or scarred.
I’d be happy to hear more interesting outcomes, particularly for “regular” humanoid combat.