I haven't played Skyrim yet, but I still agree. Every game needs a V.A.T.S system, or a least a mod for it. Throw an explosion into someone's face, or oil/grease onto their crotch followed by a fireball. Maybe swing a broadaxe and watch their blocking arm explode. Maybe just a single well placed shot to the arm to watch it sever, flailing through the air, leaving the person armless, weaponless, and in agony...
With it comes the necessarily bloody and meaty explosion from simple bullets that Fallout gave us, but I would love to see it adaptive, where just because their arm blew off doesn't mean the person dies. It just means they start running for all hell trying to get away. Now that would be fun.